Crisis Assessment, Intervention, and Prevention, 3rd edition Jackson-Cherry Instructors Manual with

Instructor’s Manual and Test Bank For

Crisis Assessment, Intervention, and Prevention

Third Edition Lisa R. Jackson-Cherry, Marymount University Bradley T. Erford, Loyola University, Maryland Prepared by Lisa R. Jackson-Cherry, Marymount University

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Table of Contents

Page

Chapter 1. Basic Concepts of Crisis Intervention……………………………................……………………………… 1 Multiple Choice Questions…………………………………………………………………………………… 1 Extended Response Questions……………………………………………………. ………………………….. 3 Multiple Choice Answers…………………………………………………………………………................... 5 Chapter 2. Safety Concerns in Crisis Situations….…………………………………….................................................. 7 Multiple Choice Questions…………………………………………………………………………………… 7 Extended Response Questions……………………………………………………………………………….. 9 Multiple Choice Answers…………………………………………………………………………................... 10 Chapter 3. Ethical and Legal Considerations in Crisis Counseling………………..………………………….. ………. 11 Multiple Choice Questions…………………………………………………………………………... ……….. 11 Extended Response Questions………………………………………………………………………………… 13 Multiple Choice Answers…………………………………………………………………………..... ………. 14 Chapter 4. Essential Crisis Intervention Skills………………………………………………………………................. 15 Multiple Choice Questions……………………………………………………………………………………. 15 Extended Response Questions……………………………………………………. ………………… ……….. 17 Multiple Choice Answers…………………………………………………………………………..... ……….. 19 Chapter 5. Loss, Grief, and Bereavement…………………………………….……………………………….. ……….. 20 Multiple Choice Questions………………………………………………………................................………. 20 Extended Response Questions………………………………………………………………………. ……….. 23 Multiple Choice Answers…………………………………………………………………………..... ……….. 24 Chapter 6. Risk Assessment and Intervention: Suicide and Homicide…………………………………………………. 25 Multiple Choice Questions………………………………………………………............................... ………. 25 Extended Response Questions………………………………………………………………………………… 28 Multiple Choice Answers…………………………………………………………………………..... ……….. 29 Chapter 7. Understanding and Treating Substance Use Disorders with Clients in Crisis…………………….. ……….. 30 Multiple Choice Questions…………………………………………………………………………………….. 30 Extended Response Questions………………………………………………………………………..……….. 32 Multiple Choice Answers…………………………………………………………………………..... ……….. 34 Chapter 8. Intimate Partner Violence……………………………………...……………………………………………. 35 Multiple Choice Questions……………………………………………………………………………………. 35 Extended Response Questions………………………………………………………………………. ……….. 37 Multiple Choice Answers…………………………………………………………………………................... 39 Chapter 9. Sexual Violence…………………………………………………………………………………… ……….. 40 Multiple Choice Questions……………………………………………………………………………………. 40 Extended Response Questions………………………………………………………………………………… 42 Multiple Choice Answers…………………………………………………………………………..... ……….. 43 Chapter 10. Child Sexual Abuse…………………………………………………………............................................... 44 Multiple Choice Questions……………………………………………………………………………………. 44 Extended Response Questions………………………………………………………………………………… 46 Multiple Choice Answers…………………………………………………………………………................... 47 Chapter 11. Military and First Responders……………………………………………………………………. ……….. 48 Multiple Choice Questions……………………………………………………….……………………………. 48 Extended Response Questions………………………………………………………………………………… 50 Multiple Choice Answers…………………………………………………………………………..... ……….. 52 Chapter 12. Emergency Preparedness and Response in the Community and Workplace................................................ 53

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Multiple Choice Questions……………………………………………………….. ………………………….. 53 Extended Response Questions……………………………………………………. ………………….……….. 55 Multiple Choice Answers…………………………………………………………………………..... ……….. 56 Chapter 13. Emergency Preparedness and Response in Schools and Universities...………..………………….………. 57 Multiple Choice Questions…………………………………………………………………………………….. 57 Extended Response Questions………………………………………………………………………..……….. 60 Multiple Choice Answers…………………………………………………………………………................... 61 Chapter 14. Counselor Self-Care in Crisis Situations…………………………………………………………………... 62 Multiple Choice Questions……………………………………………………………………………………. 62 Extended Response Questions………………………………………………………………………. ……….. 64 Multiple Choice Answers…………………………………………………………………………..... ……….. 65

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Chapter 1: Basic Concepts of Crisis Intervention Multiple Choice Questions 1.

According to authors such as James (2008) and Slaikeu (1994), a crisis A. is a perception or experience.

B. is an event.

C. is a situation.

D. always leads to a negative outcome.

2.

__________ was an early influence in the field of crisis intervention.

A. The Great Atlantic Hurricane of 1944 B. The Cocoanut Grove Nightclub fire of 1942 C. Hiroshima and Nagasaki being bombed with nuclear weapons in 1945 D. Orson Wells’ broadcast of “The War of the Worlds” in 1938

3.

Early contributors to the field of crisis intervention include all of the following EXCEPT A. Gerald Caplan.

B. Gerald Corey.

C. Erich Lindemann.

D. Reuben Hill.

4.

The study of crisis intervention began during World War II in response to A. soldiers returning from the war effort with PTSD diagnoses.

B. family reactions when loved ones left home to participate in war efforts.

C. family reactions when soldiers returned from service and resumed their civilian lives.

D. families grieving for loved ones who died in combat.

5.

A cluster of symptoms including somatic distress, feelings of guilt, hostility, disorganization, and behavior changes experienced by the surviving family members of nearly 500 individuals who died in a tragic event in the 1940s was labeled “acute grief.” A disorder that is described in the DSM that seems to parallel acute grief is A. acute stress disorder.

B. posttraumatic stress disorder.

C. adjustment disorder.

D. bereavement.

6.

According to Erich Lindemann, a psychiatrist and researcher who described acute grief, treatment for acute grief A. should be provided only by psychiatrists who may prescribe medication.

B. may be provided by psychiatrists (MDs) or psychologists (PhDs) but not counselors or social workers.

C. may be provided by paraprofessionals and helpers other than psychiatrists.

D. is not necessary.

7.

According to Raphael (2000), the full impact of trauma frequently is felt A. within 48 hours of a crisis event, during the “fight or flight” period of adjustment.

B. two to four weeks after a crisis event during the period of adjustment known as “picking up the pieces.”

C. a considerable time after the crisis event during the “disillusionment” period of adjustment.

D. after individuals or families have completed the “rebuilding” period of adjustment and can reflect on the events of the crisis in totality.

8.

According to Hill’s ABC-X model of crises, A. a crisis is caused by a stressor event.

B. as long as there are resources to meet the demands of a stressor event, there will not be a crisis.

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C. “A” represents an antecedent event, “B” represents behavioral resources, “C” represents the crisis, and “X represents treatment or intervention.

D. a crisis is the outcome of an interaction between a stressor event, resources, and cognitive processes involving perception and meaning.

9.

According to the Double ABC-X Model proposed by McCubbin and Patterson (1982), long-term change following a crisis event A. would most likely be negative.

B. would most likely be positive.

C. is not likely.

D. may be positive or negative.

10. According to the Task Model proposed by Jackson-Cherry A. in order to intervene effectively, the assessment must be accurate B. the intervention is not linked to a comprehensive assessment C. the assessment and intervention can be conducted simultaneously D. the assessment is not important in the process 11. The Task Model proposed by Jackson-Cherry utilizes the following aspects in the assessment: A. affect, behaviors, cognitions, development B. affect, behaviors, cognitions, environment, ecology C. affect, behaviors, cognitions, developmental, environment D. affect, behaviors, cognitions 12. The effects of a stressor or crisis event may be mediated by A. tangible resources such as food, clothing, and shelter.

B. intangible resources such as self-esteem and problem-solving ability.

C. external resources such as social support or government aid.

D. All of the above.

13. Which of the following statements about coping is FALSE? A. Denial may be a useful short-term coping strategy.

B. Coping often involves “fight or flight” responses.

C. Using defense mechanisms should not be considered coping.

D. Coping involves both cognitive and behavioral responses.

14. According to Boss (2002), __________ is a continuous variable, whereas __________ is a dichotomous variable.

A. distress; eustress B. stress; crisis C. organization; disequilibrium D. coping; adaptation 15. Which of the following statements with regard to trauma is TRUE? A. Traumatic events almost always involve actual death or serious injury.

B. People experiencing traumatic events respond with intense feelings of fear and helplessness.

C. Most people who experience traumatic events develop acute stress disorder or post-traumatic stress disorder.

D. All of the above.

16. A behavioral or cognitive action that is taken in an effort to manage stress is A. a coping strategy.

B. a defense mechanism.

C. adaptation.

D. a resource.

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17. Following a stressor or crisis event, the degree to which functioning has changed over an extended period of time is called A. adaptation.

B. resilience.

C. coping.

D. None of the above.

18. __________ does NOT have a positive association with resilience.

A. Attachment B. Mastery C. Cognitive skills D. Affective arousal 19. Compared to psychologists and psychiatrists, professional counselors A. are less trained and less prepared to provide crisis intervention.

B. work from a prevention point of view.

C. would not be likely to diagnose mental or emotional disorders.

D. are less effective advocates because they have Masters’ degrees rather than doctoral degrees.

20. Within the mental health community, paraprofessionals A. include counselors.

B. are not permitted to provide crisis intervention because they are not licensed.

C. may provide an outlet for clients to talk and feel less isolated.

D. None of the above.

21. Which of the following statements is TRUE? Crisis intervention A. usually occurs between counselors and clients who have no previous relationship.

B. may be a scheduled component of other forms of counseling.

C. is similar to other forms of counseling in its purpose, setting, time, and design.

D. may take place within an established ongoing counseling relationship.

22. The procedures for working with clients in crisis begin with A. establishing equilibrium.

B. assessment.

C. debriefing.

D. defusing.

23. Existential crises as defined by the applied theory are A. events that occur and experienced by the majority of individuals within a society B. unexpected and catastrophic events that are out of the control of an individual C. events that impact one’s personal meaning, purpose, and/or freedom D. man-made or natural disasters impacting an individual and systems connected to the individual 24. Ecological crises as defined by the applied theory are A. events that occur and experienced by the majority of individuals within a society B. unexpected and catastrophic events that are out of the control of an individual C. events that impact one’s personal meaning, purpose, and/or freedom D. man-made or natural disasters impacting an individual and systems connected to the individual.

Extended Response Questions 1.

Discuss how crisis intervention differs from traditional counseling (include objectives, time frame and duration, skills, diagnostic impression,

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2.

You are a counselor at a local mental health agency. You have just read the intake of a male client that you will see next week. His presenting problem is that he witnessed his brother being shot and killed. According to the ABC-X Model, what might you consider in your assessment while working with this client?

3.

According to the Task Model of Assessment and Intervention by Jackson-Cherry, what is the purpose of order of assessment followed by the intervention tasks? How does this model differ from the other proposed models in the chapter that includes the triage approach?

4. Describe the modes in which a crisis worker may work with a client in assessing a client the level of functioning.

5. Describe and give an example of the 4 categories of crises outlined in the Applied Crisis Theory:

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Multiple Choice Answer Key: 1. A 2. B 3. B 4. B 5. A 6. C 7. C 8. D 9. D 10. A 11. C 12. D 13. C 14. B 15. B 16. A 17. A 18. D 19. B 20. C 21. C 22. B 23. C 24. D

Feedback for the essay question: 1.

The response should include some items from each of the following categories: -Objectives: Traditional counseling focuses on improving functioning. Crisis counseling focuses on decreasing symptoms and stabilizations -Time frame: Traditional counseling is a clinical hour often based on managed care (45 minutes. Crisis intervention is flexible and often requires the time needed to make an assessment and determine a plan.

-Sessions: Traditional counseling often is longer term based on managed care (8 sessions or more). Crisis intervention ranges from 1-4 but often no more than 6 sessions.

-Skills: Traditional counseling uses all of the basic counseling skills and most often uses the client in the development of their plan and treatment. Formal termination is more frequent and referral is not used often. Crisis counseling may utilize more directive approaches, formal termination is rare, and referrals to other professionals are common.

-Diagnosis: Traditional counseling utilizes formal diagnosis in the treatment plan. Crisis counseling evaluates symptoms as diagnosis is often premature due to lack of time with the client.

2.

The response should include assessment information to include the following components: -Coping mechanisms -Meaning placed on the event by the client -Resources available to the client

3.

The response should include information about the components: -the order is to make an appropriate referral or integrate an appropriate treatment plan an accurate assessment must be conducted. This model differs in that it emphasizes the importance of bio-psycho-social-spiritual components. The medial and spiritual aspects are often not the focus on counselors. It also assesses the traditional components of affect, behaviors, and cognitions but also includes an intentional focus on the assessment of development issues and environment issues unique to the client.

4.

The response should include information about directive, non-directive, and collaborative crisis intervention.

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5.

The response should include definition and examples of the following: -Developmental crises (examples: birth, death, retirement) -Situational crises (example: assaults, injuries resulting in unexpected disability) -Existential crises (examples: events impacting freedom, meaning, purpose) -Ecological crises (examples: natural or man-made disasters)

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Chapter 2: Safety Concerns in Crisis Situations Multiple Choice Questions 1.

During the initial impact of a crisis, A. mental health providers begin long-term treatment planning.

B. mental health providers work independently of the crisis team.

C. mental health providers may assist with basic needs, such as shelter and food D. mental health providers are not included in the initial crisis impact

2.

Which of the following referral scenarios represents the greatest potential danger to a sole practitioner?

A. A client calls after finding your name on an online listing.

B. A lawyer you know refers a client to you.

C. A former client refers her neighbor to you.

D. A psychiatrist refers a client to you.

3.

Rapport building in cross cultural counseling may be hindered by A. sensitivity.

B. distrust of government agencies.

C. collaboration with community leaders.

D. resources and aid.

4.

A high risk suicidal client suddenly jumps up and runs from a counselor’s office. The counselor should A. call law enforcement.

B. run after the client and try to stop the client.

C. call the nearest emergency room and ask them to be on the lookout for the client.

D. call the client to schedule another appointment for follow up.

5. The most dangerous setting for counseling practice is a A. university counseling center.

B. sole practitioner in a multipurpose building.

C. counseling agency.

D. sole practitioner practicing in his or her own home.

6. A sole practitioner who experiences fear or intuitive red flags when screening a new client via phone should A. not discriminate and take on the client.

B. seek counseling for anxiety.

C. decline to see the client and be prepared for offering referral.

D. see the client but sit near a door for an escape route.

7. Counselors working with clients at high risk for violence should do all of the following EXCEPT A. secure wall framed items, such as pictures and diplomas, to the wall.

B. display family photos in a prominent place.

C. avoid wearing ties and scarves.

D. install a safety alarm.

8. The majority of stalking cases involve A. female inpatient clients.

B. male inpatient clients.

C. female outpatient clients.

D. male outpatient clients.

9. Regarding in-home counseling. All of the following are true EXCEPT that A. in-home services should be conducted alone.

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B. counselors should call their agency before and after the in-home appointment.

C. counselors should familiarize themselves with the community and environment.

D. if a counselor feels uneasy, the counselor should leave the premises.

10. Law enforcement agencies who partner with mental health professionals tend to see A. a decrease in arrest rates among violent offenders.

B. an increase in resources given for mental health services.

C. increase in crimes reported.

D. increase in arrest rates among domestic violence incidents.

11. As a best practice, counselors working with a team during an actual crisis situation for effective crisis intervention should A. be prepared to take on multiple roles.

B. be assigned one role for control over the crisis situation.

C. intervene wherever possible.

D. take on any group needed to be assessed.

12. School and universities should have a preventative plan that includes collaboration with A. hospitals.

B. mental health agencies .

C. FEMA. D. all of the above.

13. It is best for a suicidal client be transported to the hospital by anyone EXCEPT: A. the family of the client.

B. law enforcement.

C. the counselor.

D. a close friend.

14. If a client states he is willing to be voluntarily hospitalized only if the counselor rides along to the hospital, the counselor should A. take the client since this will allow the transition be more calm.

B. explain it is not permitted and ask if the client has a close friend or family member to be called.

C. call the next of kin instead of talking this through as an option.

D. none of the above.

15. The main role of law enforcement is A. provide additional supportive services.

B. increase options available to the client.

C. protect the public.

D. transportation of clients to social service agencies rather than arrests.

16. As a best practice, self-referrals should be screened by phone for A. legal history.

B. medical history.

C. medication use.

D. all of the above.

17. According to OSHA, the factors that create a dangerous work environment and high risk for assault A. changes in relationships with coworkers and family.

B. feelings of incompetence, guilt, powerlessness.

C. fear of criticism by supervisors or managers.

D. all of the above.

18. According to OSHA, it is recommended that mental health workers who have been assaulted A. have access to debriefing and counseling to address trauma and stress concerns.

B. speak to a supervisor preventative plans for future incidents.

C. take a leave of absence.

D. continue to see clients to get back working with clients.

19. Ongoing training should be provided to counselors with high risk populations that includes A. the use of self-defense.

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B. appropriate restraint practices.

C. restraint-free procedures.

D. all of the above.

20. SAMHSA puts forth six key principles for working from a trauma informed perspective: A. safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; cultural, historical and gender issues.

B. safety; trustworthiness and transparency; continuing education; collaboration and mutuality; empowerment, voice and choice; cultural, historical and gender issues.

C. safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; goal directive.

D. career awareness; trustworthiness and transparency; continuing education; collaboration and mutuality; empowerment, voice and choice; cultural, historical and gender issues.

Extended Response Questions 1.

If a counselor is deployed during an initial impact of a crisis, what might the counselor be assigned to do and what will the counselor most likely not do during this time frame of the crisis?

2.

Discuss the factors that indicate a greater risk for dangerous behaviors from a client.

3.

What safety procedures can a sole practitioner engage in when seeing a new client?

4.

If a counselor works with a population at high risk for violence, what safety steps should the counselor employ to reduce the risk of bodily harm from dangerous clients?

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Multiple Choice Answer Key: 1. C 2. A 3. B 4. A 5. D 6. C 7. B 8. D 9. A 10. C 11. B 12. D 13. C 14. B 15. C 16. D 17. D 18. A 19. D 20. A

Feedback for the essay question: 1.

The response should include definition and examples of the following: Counselors will not be assigned to provide long-term counseling, treatment planning, or long term referrals.

Counselors will most likely assist first responders who are working with victims by assisting in providing basic needs (food, shelter, connection with family members). Counselors may provide assessments of individuals who may be experiencing a crisis to intervene in order to prevent additional crises

2.

The response should include definition and examples of the following: Counselors in greater risk are those who are in solo practice, do not provide a proper pre-screening prior to scheduling the initial appointment, and work with clients requiring involuntary hospitalization. Counselors should limit personal information on websites and in offices.

3.

The response should include definition and examples of the following: screening procedures to include medical, mental health, legal history, and presenting issues; having other staff in the office area or during normal office times during initial intakes. Have safety precautions in place prior to an incident occurring.

4.

The response should include information on the following: office area set up to decrease physical risks, limited information about personal life, remove instruments or objects that could be used as a weapon. If a client leaves who is a risk to self or others, do not attempt to restrict them, rather take note of what they are wearing, in what direction they are leaving, car tags, and contact law enforcement.

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Chapter 3: Ethical and Legal Considerations in Crisis Counseling Multiple Choice Questions 1.

HIPAA stands for A. House Insurance Privacy and Accountability Act. B. Health Information Protection and Access Act. C. Healthcare Information Protection and Accessibility Act. D. Health Insurance Portability and Accountability Act.

2.

What circumstances brought about the HIPAA legislation?

A. Public perception that healthcare information was not properly controlled.

B. Public perception that healthcare information was not properly protected.

C. Concerns that information was being used to negatively affect people.

D. All of the above.

3.

Under HIPAA protected health information (PHI) is applicable to A. information containing personal identification related to healthcare.

B. paper-based medical information only.

C. the electronic transmission of medical information not containing unique identifiers.

D. all electronic correspondence from a clinic.

4.

__________ is NOT required of counselors by HIPAA. A. A privacy officer B. Procedural practices C. Deadbolt locks on medical records D. A written declaration of client rights

5.

HIPAA has adversely affected counseling practice through A. reliance on complicated consent forms.

B. helping organizations to become more willing to host research.

C. increasing research volunteers.

D. All of the above.

6.

The federal government may waive HIPAA penalties A. when requested by public health officials.

B. as long as the privacy rule has not been violated.

C. even in cases where a public emergency is not declared.

D. only when ordered by the President.

7.

Release of public health information to law enforcement is allowed only A. with a subpoena from the office of the district attorney.

B. when it is needed to identify or apprehend an escapee or violent criminal.

C. when the client has been forcibly committed for mental illness.

D. None of the above.

8.

FERPA stands for A. Family Education Rights and Privacy Act. B. Family Educational Regulation of Privacy Act. C. Federal Education Regulation and Protective Act. D. Fiscal Education Regulatory Provision Act.

9.

FERPA is also known as the A. Buckley Amendment.

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B. Privacy Amendment.

C. Bodine Act. D. Barkley Amendment.

10. FERPA bestows all of the following rights EXCEPT A. privacy of student records at age 18 years.

B. right to inspect and review the student records.

C. right to amend the student records.

D. right to obtain the original student record.

11. FERPA ended the practice of A. entering medical diagnoses in the student record.

B. placing test results in the student record.

C. untrained people entering mental diagnoses in the student record.

D. entering disciplinary actions into the student record.

12. __________ prompted the enactment of FERPA. A. Motions of the national Parent Teachers Association B. Decreased confidentiality of student records C. State board of education regulations D. None of the above.

13. According to FERPA, threatening remarks made by a student overheard by school personnel A. cannot be released from the medical record.

B. should only be released with parent consent.

C. may be released upon request from the board of education.

D. are not considered part of an educational record.

14. In many states Tarasoff v. Regents of University of California established A. the need to maintain confidentiality.

B. the ACA Code of Ethics.

C. a mental health professional’s duty to warn.

D. All of the above.

15. Duty to protect A. involves taking action to actually reduce the danger to a person.

B. was established by the U.S. Armed Services and Family Resources Division.

C. exists only in educational systems.

D. None of the above.

16. When considering breaking confidentiality due to a duty to warn, it is highly recommended that a counselor should foremost A. contact the police.

B. seek consultation or supervision.

C. get the contact information of the potential victim.

D. determine the lethality of the threat.

17. While many states have laws covering duty to warn, other states have A. laws giving only permission to warn.

B. no such law at all.

C. Both of the above.

D. None of the above.

18. __________ is not one of the “4Ds” of malpractice.

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A. B. C. D.

Dereliction Duty Distress Directly

19. Providing for locked, secured, confidential file storage in crisis situations is A. not practical.

B. to be addressed in crisis planning.

C. not expected.

D. the responsibility of FEMA. 20. In disaster circumstances, counselors are expected to obtain consent through each of the following steps EXCEPT: A. introduce themselves and explain their role.

B. describe the general limitations of confidentiality.

C. ask permission to speak with the person.

D. obtain written consent.

21. In order to avoid therapeutic abandonment in disaster circumstances the counselor should A. personally introduce the client to the local counselor he or she is being referred.

B. provide the client with a referral to local counseling services.

C. maintain periodic contact with the client to ensure care is being continued.

D. All of the above.

22. In disaster counseling, clients who bring up religious or spiritual issues should be A. referred for Christian counseling.

B. redirected in session to more concrete matters.

C. told that the counselor can’t discuss religious matters.

D. allowed to explore the disaster’s spiritual meaning in their life.

23. In disaster situations, marginalized populations will discover A. improved circumstances post-disaster.

B. that pre-disaster norms will not dictate post-disaster reality.

C. disaster is not a social leveler.

D. All of the above.

Extended Response Questions 1.

Explain how both HIPAA and FERPA impact the provision of counseling in crisis circumstances.

2.

Describe how a duty to warn would be applied in a crisis counseling circumstance. How differently might Tarasoff v.

Regents of University of California be applied in a disaster counseling circumstance?

3.

Explain the concepts of negligence and malpractice, and describe how these principles intersect. Describe how a counselor might engage in negligence or malpractice as a result of failing to assess and address spiritual and religious issues.

4.

Explain the concepts of abandonment and termination. Describe the common pitfalls of both as well as their application to crisis and disaster counseling circumstances.

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Multiple Choice Answer Key: 1. D 2. D 3. A 4. C 5. A 6. C 7. C 8. A 9. A 10. D 11. C 12. B 13. D 14. C 15. A 16. B 17. C 18. C 19. B 20. D 21. B 22. D 23. C

Feedback for the essay question: 1.

The response should include information on the following: limits of confidentiality, how to obtain consents, how information can be transmitted and shared, what information is confidential, any emergency declarations that impact FERPA; duty to warn, protect, consult.

2.

The response should include the following: (1) ensure that the client remains safe, reduce lethality, and stabilize the environment; (2) help the client to regain short-term control; and (3) connect the client with appropriate resources.

3.

The response should include the following: to prove malpractice, negligence must be evident which means the standard of care (care provided by others in the profession) was negligent or not met; Malpractice requires the 4 D’s (dereliction in the duty of care that directly impacts and causes damages).

4.

The response should include information on the following: improper or lack of appropriate termination may increase the chances of perceived or complaints of abandonment with clients who are already in crisis and may be experiencing abandonment from support groups or perceived control. Counselors can decrease these allegations or perceptions by setting boundaries, being clear about short time frame of counseling, purpose of crisis work, use of referrals in crisis work, reviewing limits of confidentiality, and reviewing termination protocols.

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Chapter 4. Essential Crisis Intervention Skills Multiple Choice Questions 1.

Counselors who develop a strong sense of accord and amity with their clients would be said to have cultivated A. genuineness.

B. empathy.

C. rapport.

D. unconditional positive regard.

2.

All of the following are at the bottom of the microskills hierarchy EXCEPT A. body language.

B. questioning.

C. eye contact.

D. tone of voice.

3.

All of the following are TRUE statements about questioning in the counseling relationship EXCEPT A. open questions can be a vehicle to glean important information, often in more depth.

B. too many questions can confuse clients and create additional stress.

C. closed questions can give more control to the client.

D. questions can help guide and focus the client.

4.

Which of the following is an example of an open question?

A. When did you first start having trouble in your marriage?

B. What goes through your head when your spouse ignores you?

C. How many times each week do you find yourself fighting with your spouse?

D. Are you thinking about getting a divorce?

5.

“Why” questions do NOT usually A. encourage clients to intellectualize their problems.

B. put clients on the defensive.

C. cause clients to rationalize their problems.

D. allow clients to explore their issues and emotions at a deeper level.

6.

A question with an answer already embedded in it is called a A. why question.

B. closed question.

C. leading question.

D. open question.

7.

Reflecting skills are NOT A. a way to elicit the facts and specific details of an issue.

B. a form of active listening.

C. a way to display genuineness.

D. a way to prompt deeper examination of a clients’ problems.

8.

Reflecting back to a client the essence of something they have shared is considered a A. summary.

B. reflection of feelings.

C. paraphrase.

D. restatement.

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9.

“I am still in shock that my husband is having an affair. I really can’t believe it. I thought we had the perfect marriage. How could I have been so stupid to not see this was happening? I feel like such a fool.” Based on this scenario from the text, choose the option that is NOT an example of an effective paraphrase.

A. You’re upset with yourself for not recognizing that something was amiss in your marriage. Is that right?

B. You feel like a fool because you thought you had a perfect marriage.

C. It’s difficult for you to come to terms with your husband’s infidelity, especially because you were under the impression that everything was fine.

D. All of the above are examples of effective paraphrases.

10. A __________ summary is most commonly used at the start of a counseling session.

A. focusing B. signal C. planning D. All of the above.

11. A __________ summary is frequently used at the end of a counseling session.

A. focusing B. signal C. planning D. All of the above.

12. A __________ summary is used to help clients transition from one topic to another and can provide direction.

A. focusing B. signal C. planning D. All of the above.

13. “What brings you to counseling?" or “What do you make of that?” are examples of A. attentive statements.

B. open questions.

C. minimal encouragers.

D. open-ended leads.

14. Open questions are helpful because open questions A. do not limit a client’s answer.

B. address specific topics.

C. allow a client to refuse to answer.

D. All of the above.

15. Reflecting feelings can A. help the client become aware of the emotions experienced in relation to the issue at hand.

B. bring the client to higher levels of self-awareness.

C. have a positive impact on the therapeutic relationship.

D. All of the above.

16. __________ is a distilled version of the content of the client’s message that restates the facts and thoughts in different words and in a nonjudgmental way.

A. Paraphrase B. Reflection of feeling C. Summarizing D. Reflection of meaning 17. Summarizing can be used to A. signal the client to address the next topic.

16 .

B. C. D.

link content or meanings across several sessions. address past progress and future directions.

All of the above.

18. An appropriate time to use a close-ended question would be A. when you want to draw out the client’s story.

B. during the termination phase of counseling.

C. when you want to help the client go deeper and elicit meaning.

D. to obtain concrete and factual information.

19. “You have let your parents down, and this is what is difficult because their trust in you is the most important thing” would best be described as a A. reflection of feeling.

B. reflection of meaning.

C. paraphrase.

D. summary.

20. The basic or core feelings we all experience as humans include each of the following EXCEPT A. anger.

B. depression.

C. sadness.

D. fear.

21. Client: “We’ve tried everything. We’ve promised to give her things if she’ll agree to stay home. We’ve tried to ground her.

What else can I do?” Choose the response that best demonstrates a paraphrase.

A. You’ve tried a lot of things, but nothing has worked.

B. Well, maybe your sister could help out.

C. When did all of this begin?

D. You feel angry that your daughter will not be more sensitive to your needs.

22. Client: (describing difficulties at work) “I try, honestly, but I don’t get anywhere. Working hard doesn’t seem to make any difference; I am still behind” Choose the response that best demonstrates a reflection of feeling.

A. I guess you are depressed.

B. It seems you must feel that working hard does not get you anywhere.

C. It sounds like you feel discouraged about your situation at work.

D. You feel hopeless about your work situation.

23. “Are you thinking of killing yourself?” and “How old were you when your parents divorced,” are examples of A. open questions.

B. closed questions.

C. open and closed questions, respectively.

D. None of the above.

24. In a crisis situation, it is best for the counselor’s tone of voice to A. match the client’s.

B. be slow and unruffled.

C. be rapid and cursory.

D. sound monotone.

Extended Response Questions 1.

Explain the basic attending skills.

2.

Discuss two situations when maintaining moderate eye contact with clients may be more harmful than helpful.

17 .

3.

What are the advantages and disadvantages of closed and open questions in crisis situations?

4.

Discuss why counselors should avoid using leading questions and “why” questions.

5. List and describe the three common types of summaries.

18 .

Multiple Choice Answer Key: 1. C 2. B 3. B 4. B 5. D 6. C 7. A 8. C 9. B 10. A 11. C 12. B 13. B 14. A 15. D 16. A 17. D 18. D 19. B 20. B 21. A 22. C 23. C 24. B

Feedback for the essay question 1.

The response should include information on the following: body posture, silence, eye contact, vocal tone/speed, presence, use of minimizers, and non-verbal behaviors.

2.

The response should include information on the following: clients who may be experiencing shame, victims of crimes, clients with high anxiety and/or paranoia.

3.

The response should include information on the following: in crisis situations, closed questions provide answers to assessment and baseline norms; often open questions may lead to premature exploration which may prevent thorough assessment. For example, suicide assessments and other risk assessments require definition and fact based answers that must be discovered prior to exploration of feelings. Closed questions can also allow a sense of control for clients who may be experiences a loss of control due to a crisis.

4.

The response should include information on the following: “why” questions often are perceived as shaming/blaming a client and can put the client on the defense which may impact rapport between client-counselor relationship.

5.

The response should include information on the following: use of summaries: beginning (to summarize a previous session to set the agenda of the current session or search for progress; middle of a session to refocus or control a session that lacks control or focus; or at the end of a session to summarize the aspects of the session and provide focus for time in between sessions.

19 .

Chapter 5: Loss, Grief, and Bereavement Multiple Choice 1.

Which of the following is NOT TRUE about grief?

A. grief is a healthy response to loss and should not be prevented.

B. grieving may affect us physically, emotionally, and cognitively.

C. all people grieve in the same way.

D. grief may exacerbate symptoms of depression and anxiety.

2.

Which of the following best describes Kubler Ross’s five stages of death and dying?

A. people move through the stages consecutively.

B. Kubler Ross later applied the same theory to grief and grieving.

C. everyone experiences all five stages.

D. all of the above.

3.

The order of Kubler Ross’s five stages of death and dying is A. denial, rage and anger, bargaining, depression, and acceptance.

B. denial, bargaining, rage and anger, depression, and acceptance.

C. rage, anger, bargaining, depression, and denial.

D. bargaining, depression, denial, rage, and anger.

4.

Which of the following is TRUE of Worden’s task model of grieving?

A. there are seven tasks of grieving that must be accomplished.

B. experiencing and working through the pain is an important task.

C. it is basically the same model as Kubler Ross’s stage theory.

D. none of the above

5.

__________ are universal reactions to grief and loss.

A. tears, depressed mood, anger, and disorganization B. tears, depressed mood, anger, and wanting to join the deceased C. tears, depressed mood, anger, and celebration of life D. tears, depressed mood, anger, and naming children after the deceased

6.

__________ is a culturally specific reaction to grief and loss.

A. naming a child after the deceased B. isolating relatives into a special area C. self-injury or destroying photos of the deceased D. all of the above.

7.

__________ are coping skills helpful to someone grieving a loss.

A. spirituality and religion B. exercise C. cognitive behavioral therapy D. all of the above.

8.

__________ is not an example of ambiguous loss.

A. the kidnapping of a child B. Alzheimer’s disease C. infertility D. death by suicide

9.

The loss of a pet can be as upsetting as the loss of a loved one. Which of the following is NOT a true statement?

A. for some people, especially the elderly, the pet is a daily (and sometimes only) source of love.

20 .

B. pets can provide affection and unconditional love.

C. most people love their pets more than their family members.

D. caring for a pet provides a reason to carry on.

10. Which of the following is NOT an appropriate way to work with a grieving child?

A. help them to develop a ritual surrounding the loss of a parent.

B. tell them mommy is an angel now and will always be watching over them.

C. put photos and photo albums around the house so they can remember their loved one.

D. encourage the bereaved parent to remarry so life can get back to normal as soon as possible.

11. Which of the following is a challenge for counselors who provide crisis counseling?

A. keeping one’s own feelings and experiences about death separate.

B. empathizing too deeply with the client’s grief.

C. compassion fatigue.

D. all of the above.

12. Which of the following would be consistent with Carl Rogers’s beliefs about working with a bereaved client?

A. accompany the client to the funeral or memorial service.

B. identify cognitive distortions that are interfering with the grieving process.

C. be fully present and responsive to the needs of the bereaved.

D. help the client find appropriate distractions from their loss.

13. What should crisis counselors do to address their own issues surrounding grief and loss?

A. share their own grief experiences with clients.

B. seek supervision.

C. avoid working with grieving clients until their own issues have been addressed.

D. refer clients to someone who specializes in grief and loss.

14. The acronym _____ represents a four question spiritual assessment.

A. LOSS B. FICA C. PETA D. BOLA 15. Which of the following items could be helpful for children who have lost a parent?

A. participating in funeral arrangements and viewing photos of the deceased.

B. keeping a transitional object that belonged to the parent.

C. maintaining stability in the home during the first year after the death.

D. all of the above.

16. Death by suicide creates special circumstances for the bereaved in addition to the loss of their loved one. Which of the following is NOT TRUE? A. some people might blame the family for the death.

B. people don’t know what to say to the bereaved.

C. death by suicide brings up concerns about one’s own mortality.

D. family members might disagree on disclosing cause of death.

17. Counselors traditionally have become involved with death notifications A. as part of a team called to give a death notification.

B. to brief a team who has given a death notification.

C. after a death and as part of the counseling process.

D. none of the above.

21 .

18. The DSM-5 recommends considering the following diagnostic impression when working with someone showing symptoms of ‘complicated grief’ due to the death of a loved one A. other specified trauma-and stressor-related disorder (e.g., persistent complex bereavement disorder) B. major depressive disorder C. bipolar disorder D. anxiety disorder 19. Death notifications should be conducted A. in person and in pairs.

B. in person and alone.

C. over the phone.

D. None of the above.

20. When working in a team with law enforcement, the main role of the crisis counselor is A. to be the point person to give the notification.

B. to be a support needed for the law enforcement officer.

C. There is no reason for a counselor to ever be in involved with law enforcement for the purpose of giving a death notification.

D. None of the above.

21. When giving a death notification, the information must be A. in plain language and with specific details of the death.

B. timely and with accurate information.

C. Timeliness is not as important as is the accuracy of the information.

D. Accuracy of information is not as important as timeliness of the information.

22. Use of technology, rather than “in person” death notifications should A. never be used.

B. be used with the same guidelines as outlined in the text.

C. be used with additional support for the survivor if permitted.

D. None of the above.

23. When giving a death notification, you should take into account A. the age of the survivors.

B. the developmental and neurological states of the survivors.

C. violent history, if known.

D. all of the above.

24. When giving a death notification, you should A. use vague statements about the death so as not to overwhelm a person.

B. use specific language so not to mislead or confuse the survivor.

C. go alone.

D. none of the above.

25. Debriefings A. are not needed after each death notification if they seemed to go well.

B. should always be conducted after a death notification.

C. can be done at a monthly team meeting to assess multiple death notifications.

D. all of the above.

26. During a death notification, counselors can assist by A. normalizing the reactions that each family member may express.

B. driving the survivor to the hospital.

C. All of the above.

D. none of the above.

22 .

Extended Response Questions 1.

Describe the symptoms of “normal” bereavement.

2.

Describe Kubler-Ross’s five stages of death and dying.

3.

How is working with bereaved children different than working with adults? What considerations must be factored in?

4.

What is the change the change in the DSM-5 that addresses complicated grief?

5.

Describe elements that should be integrated into making the most effective death notification.

23 .

Multiple Choice Answer Key: 1. C 2. B 3. A 4. B 5. A 6. A 7. D 8. D 9. C 10. D 11. D 12. C 13. B 14. B 15. D 16. C 17. C 18. A 19. A 20. B 21. B 22. C 23. D 24. B 25. B 26. A

Feedback for the essay question: 1.

The response should include information on the following: new DSM5 definition of normal bereavement, symptoms and duration of bereavement and when the symptoms exceed normal bereavement.

2.

The response could include information on the following: the original purpose of the model (a model for caregivers); what a stage model is compared to a task model; the specific stages and a description of each stage (denial, rage/anger, bargaining, depression, acceptance).

3.

The response should include information on the following: developmental differences in children and adults; adults misunderstanding the needs of children and bereavement; impact of relationship and cause of death; death of animals as instrumental in the death process; perceived guilt associated with death; decision to attend and participate in burial rituals; consistency of facts in information given to children; parents should understand the need for children to remember the deceased and importance of staying to routines for healing.

4.

The response should include information on the following: the major difference is the inclusion of bereavement as a normal reaction. New diagnostic impression of other specified trauma-and stressor-related disorder (e.g., persistent complex bereavement disorder) should be considered for complicated grief/bereavement. With this diagnosis, and explanation of the symptoms, duration, and severity should be included. Other losses due to trauma can also be included in this diagnosis.

5.

The response should include information on the following steps for an effective death notification: in person and in pairs; in time and with accurate information; in plain language; with compassion; follow up; and debriefing team members.

24 .

Chapter 6: Risk Assessment and Intervention: Suicide and Homicide Multiple Choice Questions 1.

The National Director of the Council for Suicide Education (fictitious title) should use the following statement when giving a public address: A. Over 36,000 people in the United States died by suicide.

B. Over 36,000 people in the United States chose to end their lives.

C. Over 36,000 in the United States killed themselves.

D. Over 36,000 in the United States committed suicide.

2.

Rate has to do with the number of people in a uniformly-sized group in the population so that comparisons can be made across different at risk groups. Which is the correct value below that is always associated with rate, as it relates to suicide or illness categories.

A. 12th B. 12.0 C. 10,000 D. 100,000

3.

A suicide attempt gone awry occurs when the person wanted to A. live, but died.

B. live, and survived.

C. die, and survived.

D. die, and perished

4.

__________ is an example of a false positive.

A. someone who exhibits warning signs with a suicide plan and the counselor has assessed him to be acutely at risk B. someone who expresses desire, but no intent, and the counselor has made arrangements for him to be taken to the emergency room C. someone who has lied about his intent to launch a plan, while secretly, he has been readying his papers, insurance, and will D. someone who has no intent, no capability, no desire, but does own a gun

5.

Which of the following is the TRUEST statement?

A. suicide risk is higher in emergency risk when there is a long history of chronic relationship problems.

B. a young woman who cuts on herself, with no intent to die, is at high risk for suicide.

C. someone with little ambivalence and access to a gun is considered high risk.

D. a parasuicidal person who expects someone to come home and discover them is strictly attention-seeking.

6.

__________ are considered high risk for suicide.

A. persons who have previously attempted suicide B. the elderly C. Native Americans D. all of the above.

7.

__________ is considered a warning sign of suicidal risk.

A. identifying as a survivor of abuse B. a family member who has attempted C. stable mood or behaviors D. giving things away

8.

In order of highest risk to lowest risk, which of the following is accurate, according to the NSPL concepts related to desire, intent, capability, and buffers?

25 .

A. B. C. D. 9.

desire without buffers is considered high risk. desire plus capability with buffers is considered low risk. desire plus intent with buffers is considered high risk. desire plus capability plus Intent is considered the highest risk with or without buffers.

Among the many challenges for the clinician when assessing and managing suicide risk, the __________ is NOT a concern.

A. limited availability of quality suicide intervention resources from the Internet, books, monographs, and research on best practices B. risk assessment that depends on good clinical judgment C. counselor’s internal emotional reaction (as per the Core Competencies for Assessing and Managing Suicide Risk by the AAS/SPRC) D. tension between managing the counselor’s goal to intervene and the client’s goal to end pain through suicide

10. Which of the following is accurately paired as acute or chronic?

ACUTE CHRONIC A. has reasons for living………………….has suicidal intent B. recent suicidal behavior/thoughts……..relationship problems, no intent, no plan C. has no organized plan for suicide……..high risk in hours or days D. long history of problems ……………..recent loss or significant stressor 11. Postvention involves A. assisting survivors of suicide loss after a suicide has occurred.

B. assisting individuals who have attempted suicide.

C. advocacy activities that survivors of suicide loss can do to assist in prevention.

D. All of the above.

12. Of the options listed below, __________ is considered the LEAST valid treatment option.

A. measures put in place to remove means B. a meeting or conversation with a family member about safety planning C. a paper signed by the client that he or she will not hurt oneself D. meeting twice a week 13. Crisis counselors who assist family members or friends after a suicide might expect indications of all of the following EXCEPT signs of A. trauma.

B. elevated trust in the professional community at the scene of the suicide.

C. stigma.

D. complicated mourning.

14. The homicide rate in in the United States A. is climbing.

B. is at its lowest since 1964.

C. has doubled since 1991.

D. was at 10.2 per 100,000 people in 2010.

15. On average, _____ of homicide offenders are male.

A. 20% B. 40% C. 70% D. 90% 16. The most common means by which homicide is carried out is through using A. firearms.

B. knives.

26 .

C. strangulation.

D. contract killing.

17. The primary motivation for school shootings appears to be A. academic problems.

B. school culture.

C. interpersonal rejection.

D. community mores.

18. The majority of workplace homicides involve A. love triangles.

B. robberies.

C. salary disputes.

D. fired employees.

19. According to the CDC, all of the following are dangerous workplace risk factors EXCEPT A. working from home.

B. driving a taxi.

C. contact with the public.

D. working late at night.

20. “I hate my mother-in-law. Sometimes I imagine what it would be like to run her down with my car. Seriously! I could take her out.” This indicates which level of threat?

A. lethal B. non-existent C. medium D. low 21. Medium level threat clients A. do not need to be monitored but should schedule a follow up session.

B. should be hospitalized immediately.

C. pose no threat.

D. should be monitored and may need to be hospitalized.

22. The highest risk of violent and homicidal behavior has been found in individuals with…

A. a diagnosis of social anxiety B. a dual diagnosis of substance abuse and anti-social personality disorder C. a diagnosis of schizophrenia D. a dual diagnosis of depression and borderline personality disorder 23. It is crucial that _________ be emphasized when working with homicidal clients.

A. goals for the future B. self-esteem C. values D. compliance with medication 24. This lack of community support can be thought of as a __________ that further complicates the grief process for homicide survivors.

A. secondary victimization B. reactive agent C. grief construct D. primary relief 25. When homicide survivors feel a sense of unfairness regarding the justice system, it may be helpful for them to 27 .

A. B. C. D.

let go and move on. avoid discussing specifics of the murder for one year. advocate for change. seek individual rather than group counseling.

26. Although the rates of all groups in the United States have increased as a result of suicide rates, the most alarming rate continues to be A. 10-14 year olds B. 15-24 year olds C. 35-44 year olds D. 65 year olds and older 27. Suicidal individuals who evidences that he or she may hurt himself or herself in 24 hours or less, stating specificity about a plan, intent, means, and method are considered A. chronic risk B. acute risk C. sub-acute risk D. minimal risk 28. Suicidal individuals who reveal thoughts of suicidal with less specificity, less lethal intent, and greater ambivalence about dying are considered A. chronic risk B. acute risk C. sub-acute risk D. minimal risk

Extended Response Questions 1.

Discuss your ideas for how faith-based communities could enhance their responsiveness to persons at risk for suicide.

2.

Elaborate on the connection between suicide prevention, intervention, and postvention. Offer ideas about how mental health professionals can use their advocacy skills and/or consultative skills in any of these arenas.

3.

Regarding Tarasoff v. Board of Regents of the University of California, explain how this case has influenced practice and ethical codes in respect to public protection. In what ways might state laws diverge from ethical codes regarding duty to warn?

4.

Provide examples of indicators that could be used for threat assessment in the workplace.

28 .

Multiple Choice Answer Key: 1. A 2. D 3. A 4. B 5. C 6. D 7. D 8. D 9. A 10. A 11. D 12. C 13. B 14. B 15. D 16. A 17. C 18. B 19. A 20. C 21. D 22. B 23. D 24. A 25. C 26. D 27. B 28. A

Feedback for the essay question: 1.

The response should include information on the importance of faith-communities to have referrals and resources available; importance of being non-judgmental even if faith conflicts with suicide impact; to offer education and awareness to members.

2.

The response should include information on the following: preventative measures can include awareness and information to start opening up dialogue and breaking down taboos of suicide; intervention plans should be set up prior to a suicide and can include assessment information, how to identify someone who may be suicidal, having referrals and resources available for the suicidal individuals/family members/children, etc. Like preventative measures, postvention may include various support groups for families and resources for individuals.

3.

The response should include information on the following: in many States some aspect of Tarasoff allows for the break in confidentiality when a person is at risk of killing himself/ herself (duty to protect) or if a person is identified as the victim of homicide based on reliable source (duty to warn). In duty to warn, the laws may differ depending on the reliability of the person giving the information, the intent of follow through, if preparatory behaviors have not been proven, and if there is no identifiable person to warn.

4.

The response should include information on the following: the threat being direct/plausible, the source being reliable, preparatory behaviors are reported or assessed, prior attempt are evident/assessed, and/or if steps have been taken to carry out the plan.

29 .

Chapter 7: Understanding and Treating Substance Use Disorders with Clients in Crisis Multiple Choice Questions 1.

One of the main concerns with nonmedical prescription opiate use is A. withdrawal is more dangerous than with traditional opiates due to purity levels.

B. the ease of which the substances are available from family and friends.

C. overdose can happen much quicker than with heroin due to concentration and potency.

D. relapse prevention is more difficult than with other substances due to addiction potential.

2.

All of the following are examples of hallucinogens EXCEPT A. ketamine.

B. mescaline.

C. phencyclidine.

D. codeine.

3.

One outcome of the Comprehensive Drug Abuse Prevention and Control Act of 1970 was to A. develop a classification system for all drugs.

B. establish treatment parameters for various treatment placements.

C. identify safe manufacturing practices for drug companies.

D. provide legal guidelines for interstate commerce.

4.

What is the fastest way for a drug to reach one’s brain?

A. injecting into the vein B. ingesting C. mucous membrane D. inhaling

5.

__________ is the psychoactive drug with the highest dependence potential.

A. caffeine B. LSD C. PCP (smoked) D. heroin (IV)

6.

The __________ model of addiction holds that clients who develop chronic alcohol dependence and continue drinking or ever return to heavy drinking will likely die.

A. biological/genetic B. disease C. neurotransmitter D. multicausal

7.

All of the following are viewed as possible causes of addiction from the psychodynamic model EXCEPT A. negative experiences associated with one's support systems are at the root of one developing addiction.

B. history of psychopathology is a precursor for addiction.

C. dysfunctional attachment with parents or other providers during childhood.

D. substance problems develop due to poor affect regulation.

8.

__________ is the BEST contributing factor to initial substance use for adolescents?

A. lowered self-esteem B. intimacy issues C. educational achievement D. availability of the substance

9.

The proper treatment sequence when addressing substance use disorders is 30 .

A. B. C. D.

screening, testing, diagnosis, assessment, treatment placement. assessment, testing, screening, treatment placement, diagnosis. screening, assessment, testing, diagnosis, treatment planning. treatment planning, screening, assessment, testing, diagnosis.

10. The easiest way to screen for potential substance use problems is to A. use the SASSI-3, MAST, or AUDIT screening tools.

B. use the DSM-5.

C. use the frequency and amount questions.

D. conduct a clinical interview.

11. Which of the following statements BEST describes the NIAAA's recommended level of daily drinking for men and women?

A. women and men should consume no more than four drinks a day.

B. women should consume no more than one drink a day and men no more than two drinks a day.

C. women should consume no more than two drinks a day and men no more three drinks a day.

D. no alcohol should be consumed.

12. What is the main purpose of conducting an assessment?

A. identify the specific condition(s) and a basis for treatment interventions.

B. gather clinical data to get an accurate picture of the client's issues.

C. to assess whether further information is necessary.

D. to determine whether treatment planning has been beneficial.

13. The best tool for use in conducting a clinical assessment is the A. DSM-5 or ICD-10.

B. SASSI-3.

C. clinical interview.

D. mental status exam.

14. Counselors must remember that when conducting an assessment A. information will continually need to be updated.

B. self-report data may create some inherent bias.

C. counselors must assess level of motivation.

D. all of the above.

15. Which of the following statements best reflects client's reporting of AOD use?

A. clients tend to over report alcohol consumption.

B. clients tend to underreport drug use.

C. clients tend to over report criminal activity.

D. none of the above.

16. The __________ stage of Prochaska and DiClemente's stages of change model proposes that the counselor focus exclusively on using motivation techniques.

A. precontemplation B. contemplation C. maintenance D. preparation 17. Integrating behavioral approaches is most likely to occur during the __________ stage of Prochaska and DiClemente's stages of change model.

A. precontemplation B. contemplation C. action 31 .

D. preparation 18. All of the following are true for client's dealing with relapse EXCEPT that A. both intrapersonal and interpersonal factors must be examined.

B. counselors should start addressing relapse issues early in the treatment process.

C. relapse often means the client has lost much of the progress made prior to the relapse.

D. relapse most commonly occurs in the first 30 days following treatment.

19. Jackson-Cherry identified a two-tiered task model of crisis intervention. What is the proper sequence of activities for the assessment tasks?

A. safety/risk; bio-psycho-social-spiritual; clarification of problem; coping skills B. safety/risk; bio-psycho-social-spiritual; coping skills; clarification of problem C. obtaining commitment, examining alternatives, providing support D. ensuring client safety, providing support, making plans 20. Which of the following would NOT be considered a form of harm reduction?

A. a detoxification program as part of a treatment program B. a needle exchange program at a homeless shelter C. availability of free condoms at a halfway house D. free taxi service on New Year's eve sponsored by MADD 21. An advantage of using an integrated substance abuse and mental health approach when treating clients with co-occurring disorders is A. it significantly lowers rate of relapse.

B. individualized planning and personalization of services.

C. it increases the availability of treatment funding.

D. clients can address concerns quickly.

22. Counselors should be knowledgeable of multicultural competencies. Which of the following is NOT considered one of these competencies?

A. counselor awareness of own cultural values and biases B. awareness of client’s worldview C. intervention strategies that are culturally appropriate D. understanding that all counseling is multicultural counseling 23. The number of adults currently struggling with co-occurring disorders ranges from A. 1-3 million.

B. 4-6 million.

C. 7-10 million.

D. 11-15 million.

24. The DSM-5’s reclassification of substance abuse and dependence into the new umbrella term, substance use disorders, was done to address the ambiguity and confusion between the terms A. dependence and addiction B. dependence and use C. addiction and use D. use and comorbidity

Extended Response Questions 1.

Identify and discuss Prochaska and DiClemente's stages of change and why we need to be concerned about client motivation as part of our treatment consideration. What treatment approaches would be appropriate for each stage?

32 .

2.

A mental health counselor was called to the emergency room to assist with a client who arrived in crisis. Discuss some of the issues the counselor may need to consider to effectively manage this situation.

3.

Discuss the differences in classification of substance use disorder in the DSM-5

33 .

Multiple Choice Answer Key: 1. B 2. D 3. A 4. D 5. D 6. B 7. A 8. D 9. C 10. C 11. A 12. B 13. C 14. D 15. D 16. A 17. C 18. C 19. A 20. A 21. B 22. D 23. C 24. A

Feedback for the essay question: 1.

The response should include information on the following: the five stages of change (pre-contemplative, contemplative, preparation, action, maintenance); motivational interviewing (MI) as an appropriate technique that focuses on motivation, resiliency, and change; and using the MI strategies of engaging, focusing, evoking, and planning.

2.

The response should include information on the following: assessment of quantity of use, frequency of use, use in last 30 days, progression of use, route of use; previous attempts to recover, current level of functioning, family issues, employment history, educational history, mental health history, risk assessment, sexual history, other medication use.

3.

The response should include information on the following: prior to the DSM5, there were two main categories: dependence and abuse. The reclassification of the DSM5 utilizes substance use in order to address the confusion of abuse and dependence. The new classification allows for assessment of severity and progression of use.

34 .

Chapter 8: Intimate Partner Violence Multiple Choice Questions 1.

The term “intimate partner violence” describes violence among A. only lesbian or gay couples.

B. only couples who are married or cohabitate.

C. only couples who are sexually intimate.

D. any couple.

2.

Approximately _____ percent of women and ____ percent of men experience some form of partner violence.

A. 50; 14 B. 22, 14 C. 95, 40 D. 25, 22

3.

According to Walker’s Cycle of Violence Theory (1979), the __________ phase is characterized by repentance and expressions of love from the abusive partner. During this phase the survivor may feel a range of emotions from love to humiliation.

A. tension building B. acute battering incident C. honeymoon D. recovery

4.

According to __________ theory, an abused partner learns through repeated unsuccessful attempts that efforts to control violence in the relationship are ineffective, resulting in passiveness or diminished motivation to respond to violence.

A. constructivist B. ecological C. learned helplessness D. person-centered

5.

__________ theory originated from a study that involved locking dogs in cages and administering electric shocks.

A. constructivist B. ecological C. learned helplessness D. person-centered

6.

The prevalence of intimate partner violence among LGBT couples is __________ in heterosexual couples.

A. less than B. greater than or equal to C. greater among gay male couples and less among lesbian couples than D. none of the above.

7.

During middle school and high school, females and males report similar rates of dating violence victimization.

Approximately _____ percent of students report being hit, slapped, or physically hurt by a partner.

A. 3 B. 9 C. 35 D. 50

8.

50All of the following are goals of intimate partner violence crisis counseling EXCEPT A. attending to physical injury.

B. establishing immediate safety.

35 .

C. reviewing the client’s life history to determine what lead to involvement with an abusive partner.

D. collaborative decision making about reporting abuse to the police.

9.

In which of the following situations would a counselor be required to break confidentiality related to intimate partner violence?

A. IPV is against the law and should always be reported to the police.

B. no children in the household or exposed to IPV. C. the IPV survivor reports suicidal or homicidal ideation.

D. all of the above.

10. __________ could be characterized as intimate partner violence.

A. threatening to withhold sex B. threatening to “out” a same sex partner C. repeated threatening text messages, phone calls, and emails D. all of the above.

11. Due to the prevalence of intimate partner violence, it is generally agreed that screening for IPV should occur A. when the counselor or healthcare worker observes signs of physical injury.

B. when a client’s family of origin issues predispose the client to abusive relationships.

C. universally -- IPV screening should occur as routinely as screening for suicidal or homicidal ideation.

D. only in the presence of both partners, since both males and females can be considered perpetrators of intimate partner violence.

12. The prevalence of intimate partner violence is highest in which of the following groups?

A. married women who are separated from their abusive husbands B. married women who are live with their abusive husbands C. unmarried women who live with an abusive male partner D. rates of violence are similar across these groups 13. Survivors of intimate partner violence frequently experience A. depression.

B. post-traumatic stress disorder.

C. alcohol and drug abuse.

D. all of the above.

14. All of the following are goals of batterer intervention programs EXCEPT A. ensuring the safety of IPV survivors.

B. preventing future acts of intimate partner violence.

C. increasing the abusive partner’s accountability for his or her violent actions.

D. encouraging the abusive partner to contact IPV survivor to express remorse.

15. All of the following questions or statements should be included when screening for intimate partner violence EXCEPT: A. please describe the first time your partner was violent toward you.

B. no person deserves to be treated this way. Let’s explore leaving your partner.

C. what does a typical incidence of violence involve?

D. do you or your partner have access to weapons?

16. According to __________ theory, violence is a learned behavior and engaging in violence is a choice. This theory also views ending violence as a process.

A. power and control B. moral development C. learned helplessness D. attachment

36 .

17. According to moral development theory, a 22 year old, male, college student who kicks and burns his girlfriend only on her stomach and upper thighs so that she will not have injuries that are visible to her friends, parents, and teachers operates at the __________ level of development.

A. preconventional B. conventional C. postconventional D. intentional 18. According to moral development theory, the majority of batterers operate at the __________ level of development.

A. preconventional B. conventional C. postconventional D. intentional 19. Batterer intervention programs based on __________ assert that IPV includes behaviors that are aimed at maintaining an imbalance of power in a relationship.

A. attachment theory B. feminist informed cognitive behavioral theory C. moral development theory D. person centered theory 20. Intimate partner violence prevalence data probably __________ the actual rates of IPV. A. overestimate IPV experienced by women and underestimate IPV experienced by men B. overestimate C. underestimate D. accurately reflect 21. Common challenges encountered by batterer intervention programs include A. limited financial resources.

B. distinguishing their services from anger management programs.

C. underreporting of IPV. D. all of the above.

22. __________ can experience intimate partner violence.

A. heterosexual married women B. heterosexual married men C. gay men in a dating relationship D. all of the above.

23. What term is the legal concept used for crime reporting and law enforcement intervention A. domestic violence B. intimate partner violence C. battering violence D. intimate domestic violence

Extended Response Questions 1.

Describe how you would discuss the pros and cons of reporting IPV to the police with a client who reports being physically injured and raped by her husband.

2.

Most experts agree that IPV prevalence rates underestimate the actual prevalence of IPV. Provide an explanation for why IPV is underreported. Consider the impact of diverse cultural identities on IPV reporting.

3.

How is learned helplessness associated with IPV/DV? 37 .

4.

Choose a multicultural group and describe the unique circumstances a crisis counselor would need to be aware of when working with the person in the group.

38 .

Multiple Choice Answer Key: 1. D 2. B 3. C 4. C 5. C 6. B 7. B 8. C 9. C 10. D 11. C 12. A 13. D 14. C 15. B 16. A 17. A 18. A 19. B 20. C 21. D 22. D 23. A

Feedback for the essay question: 1.

The response should include information on the following: first clients’ decision of reporting to police should be assessed as to what is the best solution for the client based on his/her situation. If the client reports sexual assaults, increased violence with use of weapons, children being assaulted, then the client should know the increased risk self and family. Information about restraining orders and legal issues should be discussed.

2.

The response should include information to include any of the following: data for most incidents of IPV/DV are from law enforcement and community clinics. Incidents reported to counseling centers may not report. Many do not report due to staying in IPV relationships. Males often have a decreased likelihood of reporting.

3.

The response should include information to include the concept of learned helplessness and the thought that no matter how a victim behaves, they cannot accurately predict the abuse of the perpetrator.

4.

The response should include information to include specifics on the groups that often integrate the patriarchal family system, impact of religious/spiritual beliefs, socioeconomic status, disability status, elder abuse and caretakers, dating violence, or immigrant status.

39 .

Chapter 9: Sexual Violence Multiple Choice Questions 1.

National Organization for Women (NOW) drew attention to the issue of sexual assault by A. developing rape task forces.

B. protesting outside small and large businesses.

C. demanding all women to speak up.

D. none of the above.

2.

The prevalence of being the victim of some type of sexual assault sexual assault in the United States is __percent for women and ____ percent for men A. 34, 20.

B. 25, 25 C. 44, 22.

D. 50, 10.

3.

Women with the history of rape before the age of 18 years old are _____ times as likely to be raped when they are adults.

A. two B. three C. five D. ten

4.

Individuals who may lack the capacity to give consent include A. minors.

B. people with mental disabilities.

C. people who may be intoxicated.

D. all of the above.

5.

One of the most prevalent acts within the area of sexual assault is A. drug facilitated rape.

B. acquaintance rape.

C. spousal rape.

D. statutory rape.

6.

Rape myths include A. rape is about sex.

B. victims of rape deserve to be raped due to their appearance or their neglect of safety issues.

C. victims of rape often make false reports based on revenge.

D. All of the above.

7.

According to Burgess and Holmstrom (1974), during the acute phase of women’s response to sexual assault the survivor experienced a heightened stress level, lasting A. a few days.

B. for several months.

C. just a few hours.

D. from several days to multiple weeks.

8.

According to Burgess and Holmstrom (1974), the reorganization phase was A. a shorter-term process of integration, during which the victim regained a sense of control over her life.

B. a longer-term process of integration, during which the victim regained a sense of control over her life.

C. equivalent to the acute phase of women’s response to sexual assault.

D. None of the above.

40 .

9.

Symptoms of rape trauma syndrome include all of the following EXCEPT A. depression.

B. rage.

C. continuing anxiety.

D. hypersomnia.

10. Physical reactions to sexual assault can manifest in varying somatic complaints including A. sleep disturbances.

B. hyperalertness.

C. impaired memory.

D. all of the above.

11. Sexual assault victims may experience a wide range of emotions, including A. guilt about surviving the attack.

B. self-blame about not being able to stop the attack.

C. anxiety about another attack.

D. all of the above.

12. A sexual assault occurs every ____ minutes in the United States.

A. 12 B. 30 C. 2 D. 47 13. The National Organization for Women (NOW) raised the awareness of sexual assault through rape task forces designed to A. investigate rapes in their communities.

B. document rape statistics and victim experiences.

C. advocate for change in public policy.

D. All of the above.

14. Studies indicate that rape is reported A. equally among race ethnicity; there are no divides.

B. more frequently in Native American and Alaskan Native populations.

C. more frequently in Caucasian Americans.

D. more frequently in African Americans.

15. __________ rape is the most common rape, defined by conquest.

A. power B. acquaintance C. anger D. statutory 16. Rape is considered which of the following DSM-5 paraphilias?

A. sexual sadism B. pedophilia C. voyeurism D. none of the above 17. Rape is typically about A. sex.

B. high testosterone levels that can’t be controlled.

C. power and control.

D. None of the above.

41 .

18. The cluster of symptoms experienced by women following a sexual assault is knows as A. rape trauma syndrome.

B. victim trauma syndrome.

C. assaulted trauma syndrome.

D. perpetrated trauma syndrome.

19. __________ is an additional physical effect which should be assessed for when working with a sexual assault victim.

A. sleep disturbance B. impaired memory C. pregnancy/STI’s D. all of the above.

20. When assessing the emotional reactions to sexual assault, treatment is only suggested for those experiencing A. strong emotional reactions such as crying or screaming.

B. no emotional reaction, just silence.

C. those experiencing an equal ratio between strong versus controlled emotions.

D. None of the above 21. The most important aspect when first meeting a sexual assault victim is A. to refer to the hospital immediately.

B. support the victim’s wants and needs.

C. to refer to law enforcement immediately.

D. All of the above.

22. Crisis counselors must be aware of how to __________ in order not to impede the medical exam process for sexual assault victims.

A. explain the process B. obtain a urine sample C. Both of the above.

D. None of the above.

23. The most favorable approach for immediate intervention with sexual violence victims A. A. cognitive behavioral approaches B. narrative therapies C. psychological first aid (PFA) D. psychodynamic approaches 24. According to the 2011 National Intimate Partner and Sexual Violence Survey ___percent of female respondents and ___percent of male respondentswho experienced “contact exual violence” also experienced one or more symptoms of PTSD. A. 20, 5 B. 10, 10 C. 30, 20 D. 50, 40

Extended Response Questions 1.

Define and describe the differences in sexual assault and rape.

2.

Describe four types of rape.

3.

Discuss the most favorable intervention in the immediate impact for victims of sexual assault and rape and components of the intervention.

4.

Discuss two types of long term mental health treatments for victims of sexual assault and rape.

42 .

Multiple Choice Answer Key: 1. A 2. C 3. A 4. D 5. B 6. D 7. D 8. B 9. D 10. D 11. D 12. C 13. D 14. B 15. D 16. A 17. C 18. A 19. D 20. D 21. B 22. C 23. C 24. A

Feedback for the essay question: 1.

The response should include information on the following: rape being forced sexual intercourse and sexual assaults having varying degrees of sexual contacts and intimidation/coersion.

2.

The response should include information on four of the following: acquaintance rape, statutory rape, power rape, anger rape, sadistic rape

3.

The response should include information on psychological first aid (PFA). Components of PFA include: (1) contact and engagement, (2) safety and comfort, (3) stabilization, (4) information gathering, (5) practical assistance, (6) connection with social supports, (7) information on coping support, and (8) linkage with collaborative services.

4.

The response could include information on any of the following: Cognitive Behavioral Therapy, Cognitive Processing Therapy, Prolonged Exposure Therapy, EMDR, Anxiety Management, Stress Inoculation, Relaxation, Group therapy.

43 .

Chapter 10: Child Sexual Abuse Multiple Choice Questions 1.

Approximately ___percent of child sexual abuse is perpetrated by strangers.

A. 10 B. 20 C. 30 D. 40

2.

Approximately _____ percent of male survivors of child sexual abuse disclose that abuse.

A. 10 B. 20 C. 30 D. 40

3.

Approximately _____ percent of female survivors of child sexual abuse disclose their abuse.

A. 10 B. 20 C. 30 D. 40

4.

According to the Child Abuse Prevention and Treatment Act, to be classified as child sexual abuse, a person must be A. at least 4 years older than the child.

B. at least 6 years older than the child.

C. a parent or caretaker of the child.

D. an individual known to the child.

5.

When a child makes an initial disclosure it is important that counselors A. do a thorough investigation regarding details of the abuse.

B. use developmentally appropriate tools, like dolls, to have children identify where they have been touched.

C. give children options to help determine who the perpetrator of sexual abuse is.

D. communicate belief of and support for the child.

6.

__________ may be particularly vulnerable to child sexual abuse.

A. Caucasian children and adolescents B. Children and adolescents living below the poverty line C. Children that are below age 12 years D. Children and adolescents with disabilities

7.

In the immediate wake of abuse events, more resilient survivors of traumatic child sexual abuse appear to use A. emotion-focused coping strategies.

B. avoidant coping strategies.

C. approach coping strategies.

D. problem-focused coping strategies.

8.

Over the longer term, more resilient survivors of traumatic child sexual abuse appear to use A. emotion-focused coping strategies.

B. avoidant coping strategies.

C. approach coping strategies.

D. problem-focused coping strategies.

9.

__________ are more likely to engage in grooming potential target children A. Regressed pattern of situational perpetrators 44 .

B. Inadequate pattern of situational perpetrators C. Seduction pattern of preferential perpetrators D. Introverted pattern of preferential perpetrators 10. Although female perpetrators of child sexual abuse appear to be fewer in number than their male counterparts, all of the following aspects need to be considered EXCEPT A. wider social acceptance of females as the primary caregivers of children.

B. wider social acceptance of older females seducing younger males.

C. higher numbers of females in child-care and education positions.

D. wider social acceptance of females performing intimate child-care tasks without suspicion.

11. When treating perpetrators of sexual abuse, all of the following must be taken into account EXCEPT A. client dynamics.

B. treatment setting.

C. treatment mandate.

D. treatment modality.

12. Estimates of the number of children sexually abused each year range from approximately A. 40,000–140,000.

B. 80,000–180,000.

C. 240,000–340,000.

D. 500,000–600,000.

13. Estimates of the number of children who are sexually abused each year are considered underestimates for each of the following reasons EXCEPT that A. often those who are sexually abused are also physically or psychologically abused, so they are classified differently.

B. the definitions of child sexual abuse may not include some types of sexual abuse or molestation (e.g., strangerperpetrated).

C. children may not report the sexual abuse, and therefore a report is not filed.

D. children who disclosed their abuse may not have had it substantiated.

14. __________ is thought to change children’s behavior when looking at sexual abuse prevention programs?

A. Inclusion of information on personal boundaries in the presentation B. Inclusion of role-playing or practice activities C. Inclusion of media depictions of child sexual abuse perpetrators D. Use of an evidence-based program 15. The primary difference that delineates child sexual abuse from statutory rape is A. the relationship between two persons (caretaker/noncaretaker).

B. consent of the female.

C. difference in age between the persons.

D. All of the above.

16. Which early childhood behavior should raise a flag in a counselor’s mind about the possibility of CSA? A. a four year old who touches his genitals several times per day.

B. a two year old who lifts her shirt and/or skirt several times per day.

C. a four year old that holds down her brother forcibly while rubbing against him with her genitals.

D. a two year old boy who frequently points to other male’s genitals.

17. Which middle childhood behavior should raise a flag in a counselor’s mind about the possibility of CSA? A. sudden loss of interest in being with friends.

B. sudden and unexplained generalized anxiety.

C. sudden drop in school performance.

45 .

D. all of the above.

18. All of the following are hotly contested issues around child sexual abuse EXCEPT A. girls tend to internalize their symptoms of CSA, while boys tend to externalize.

B. existence of CSA. C. definition of CSA. D. prevalence rates of CSA. 19. Potential reasons that some children appear to not suffer any adverse effects from CSA include all of the following EXCEPT that A. some children just really are resilient.

B. researchers may be choosing the wrong symptoms for study.

C. the function of the sleeper effects principal.

D. parents often instruct children to lie about their abuse effects in research studies.

20. All of the following are documented reasons that children fail to disclose sexual abuse EXCEPT that they A. forget about it.

B. fear that others will blame them.

C. fear not being believed.

D. feel overwhelming guilt and shame.

Extended Response Questions 1.

What are some of the general warning signs in children that should indicate a clinician needs to consider potential sexual abuse while conceptualizing and/or assessing the client?

2.

What is the “grooming process” and how does this psychological trick serve to trap children in colluding in their own abuse?

3.

In the moment of disclosure when a child reveals that he is being sexually abused, what nonverbal and verbal responses should the crisis counselor provide?

4.

What are the child abuse reporting procedures that should be followed when discovery is made that sexual abuse has or might have taken place?

46 .

Multiple Choice Answer Key: 1. B 2. C 3. B 4. C 5. D 6. D 7. B 8. C 9. C 10. C 11. B 12. B 13. A 14. B 15. A 16. C 17. D 18. B 19. D 20. A

Feedback for the essay question: 1.

The response should include information that discusses the importance of looking at changes in behaviors (physical, psychological, cognitive) from prior to the alleged abuse (a baseline) to after the alleged abuse while looking at developmentally appropriate behaviors. An extensive list is listed in the chapter. It is also important to look at victims who may not demonstrate symptoms at all depending on the abuse they experienced. Additionally, information regarding medical signs such difficulty urinating, reported discomfort in the genital areas, and sexually transmitted diseases may be symptoms to allow for further assessment.

2.

The response should include information on the cycle of child sexual abuse and specifically the first stage of enticement, engagement and entrapment. This stage leads to more frequent and intensity of sexual abuse which often results in suppression of the abuse. In addition, psychological tricks may include threats of harm to family members and pets, threats the child will not be believed, and telling the child they asked for the sexual abuse or they enjoyed the abuse.

3.

The response should include information for counselors or adults to respond to the disclosure with informed intention—the intent to do no further psychological harm to the victim with statements that may be perceived as blaming. This includes the verbal and nonverbal responses made directly to survivors as well as the steps taken in the aftermath of the disclosure to respond appropriately. The worst long-term outcomes for clients with histories of CSA are consistently found in those children who met with unsupportive verbal or nonverbal responses following their disclosure of sexual abuse.

4.

The response should include information on the following: Child Protective Service (CPS) workers will ask the parent’s name and address, nature and extent of the condition observed, actions taken by the reporter (e.g., talking with the child), identity of alleged perpetrator, type of abuse reported, timeframe of the abuse, where the abuse occurred, potential risk for other children, location of the perpetrator in the home, threat of additional abuse for the child disclosing information, reporter’s name, location, and contact information. As much information gathered to be provided to the CPS worker will assist in the protection of the child.

47 .

Chapter 11: Military and First Responders Multiple Choice Questions 1.

__________ of military families resides in civilian communities?

A. One-fourth B. One-half C. Three-quarters D. Two-thirds

2.

Which statement best characterizes the current landscape of military service members?

A. Almost all service members are married and have children.

B. Slightly more than half of military service members are married.

C. The current makeup of the military is fairly consistent with historical trends of single males comprising a majority of the military.

D. Slightly more than a quarter of military service members are married.

3.

A survey of military dependents seeking counseling services associated with deployment stress indicated A. they are unlikely to and have not used counseling services.

B. a significant majority have used or are likely to use counseling services.

C. most largely talk to fellow military dependents as opposed to counseling services.

D. about half have used or are likely to access counseling services to address these types of issues.

4.

A counselor working with service members should consider each of the following elements EXCEPT A. the culture of the military is largely monolithic.

B. there exists significant within and between group differences in the military such as unique cultures in different branches.

C. there is a need to consider the culture of the military when providing counseling to service members.

D. the degree the service member or family member subscribes to aspects of the military culture.

5.

The __________ stage of deployment involves partners relying on alternative sources of support and forming new roles and norms for the household.

A. predeployment B. deployment C. reunification D. redeployment

6.

Which statement accurately describes the issues related to deployment in recent conflicts in Afghanistan and Iraq experienced by military service members?

A. The proportion of physical and psychological injuries is about equal.

B. The proportion of physical injuries outstrips psychological issues.

C. The proportion of psychological issues outstrips physical injuries.

D. The proportion of physical and psychological injuries is consistent with previous conflicts.

7.

__________ has been characterized as the “signature wound” of the recent conflicts in Afghanistan and Iraq.

A. Post-traumatic stress disorder B. Adjustment disorder C. Generalized anxiety disorder D. Traumatic brain injury

8.

Issues for nondeployed family members experiencing deployment often involves A. increased stress due to the managing tasks of a household and concern for partner.

B. a slight increase in stress though enhanced access via technology to alleviate anxiety.

C. delayed acknowledgement of stress due to the concern for responsibilities at home.

48 .

9.

D. increased likelihood of substance abuse for a nondeployed partner due to ineffective coping skills.

The concept of “resilience” as it relates to post-traumatic stress disorder involves A. focusing on remediating the symptoms of this disorder once determined to be present.

B. providing information on the disorder prior to deployment to prevent its development.

C. focusing on psychoeducational discussions, enhancing awareness of experiences, and positive emotional experiences and social bonds.

D. All of the above.

10. The __________ approach is commonly used to addressing issues of post-traumatic stress.

A. psychodynamic B. narrative C. gestalt D. cognitive-behavioral 11. Veterans who have had family members involved in treatment for post-traumatic stress disorder have A. indicated a desire for their inclusion though it has not been demonstrated to be beneficial.

B. not indicated a desire for their inclusion though it has been demonstrated to be beneficial.

C. indicated a desire for their inclusion and it has been demonstrated to be beneficial.

D. not indicated a desire for their inclusion and it has not been indicated to be beneficial.

12. Positive religious practices have been indicated to be __________ to posttraumatic growth and __________ to posttraumatic stress.

A. inversely related; directly related B. unrelated; directly related C. directly related; inversely related D. directly related; unrelated 13. The most recent research conducted by the Military Times (2015), found which of the following deployment factors contributed to the highest rate of completed suicides A. one deployment B. two deployments C. more than two deployments D. no deployments 14. The highest rates of suicide occurred among which group of military A. multiple deployments B. separation from the military C. history of suicidal behavior D. reservists 15. The main priority of law enforcement is A. crime fighting B. safety of the community and personal safety C. crime prevention D. crime solving 16. The following stressors are evident for law enforcement A. shiftwork B. exposure to traumatic situations C. relationship issues D. all of the above 17. A law enforcement officer dies in the line of duty A. an average of one death every 60 hours B. an average of one death every 60 days C. an average of one death every 60 weeks D. an average of one death every minute 49 .

18. Law enforcement officers are____________ than the general population to display suicide ideation, behaviors, and PTSD symptoms due to increased exposure to trauma A. 2 times more likely B. 4 times more likely C. 6 times more likely D. there is no difference than in the general population 19. EMS professionals report the calls that cause the most stress are incidents involve A. serious injury to children B. serious injury or death of a colleague C. having a patient die in their care.

D. all of the above 20. According to the Centers for Disease Control and Prevention (2012) EMS professionals in the United States experience PTSD and suicide ideation ________than the 3.6% national average for the general public A. 2 times greater B. 5 times greater C. 10 times greater D. there is no difference than in the general population 21. ____ of all EMS professionals reported a line of duty injury, usually due to transport A. 1 in 2 B. 1 in 3 C. 1 in 4 D. 1 in 5 22. Most line of duty fatalities among fire fighters were attributed to A. sudden cardiac deaths B. assaults C. injuries on calls D. suicides 23. PFA identifies five imperative phases to be integrated with first responders A. assessment phase; stabilization phase; triage phase; communication phase; and hotline phase B. assessment phase; control; triage phase; communication phase; and hotline phase C. assessment phase; stabilization phase; triage phase; communication phase; referral.

D. assessment phase; stabilization phase; control; communication phase; referral.

24. ______is the most common intervention to decrease the level of stress resulting from emergency calls A. critical incident stress debriefing (CISD) B. psychological first aid (PFA) C. cognitive behavioral therapy (CBT) D. first response resiliency program (FRP) 25. ______ focuses on increasing resiliency skills coupled with a strong social support system to decrease or prevent mental health issues A. critical incident stress debriefing (CISD) B. psychological first aid (PFA) C. cognitive behavioral therapy (CBT) D. first response resiliency program (FRP)

Extended Response Questions 1.

Describe how a counselor would intervene from a systemic perspective to support a family who has recently learned that an active-duty family member is being deployed.

2.

Describer and apply the concepts outlined in CISD to a shift that lost a law enforcement officer, EMS, or firefighter in the line of duty.

50 .

3.

Describe what Psychological First Aid (PFA) identifies as the five imperative phases to be integrated with first

responders.

4.

Discuss assessment questions that would be assessed with every military member to formulate the appropriate presenting issue and treatment plan essential in forming the presenting issue:

51 .

Multiple Choice Answer Key: 1. D 2. B 3. D 4. A 5. A 6. C 7. D 8. A 9. C 10. D 11. C 12. C 13. D 14. B 15. B 16. D 17. A 18. B 19. D 20. C 21. C 22. A 23. A 24. A 25. D

Feedback for the essay question: 1.

The response could include information on the following: understanding of the military culture and mission; understanding of the roles of the family members and expectations when deployed; impact of deployment on the family; awareness of supports available and special need of the family; understanding of previous deployments and issues that could assist or need to be addressed for the current deployment. If it is a first deployment, the counselor would also want to assist in preparing for the deployment and what issues could be expected for the couple.

2.

The response should include information on any of the following but also relies on reading done in Chapter 12 and applied to this chapter: Introduction Phase: setting the rules and tone of discussion; Fact Phase: discussion of what happened during the crisis from each person’s perspective; Thought Phase: Clients discuss the main emotion and cognition they experienced while going through the crisis; Reaction Phase: Clients discuss the worst part of the crisis; Symptom Phase: Clients describe their symptoms of distress during and after the crisis; Teaching Phase: Teach ways to reduce stressors and the impact of stress; and Re-entry Phase: Counselor answers questions and summarizes comments.

3.

The response should include information on the 5 phases of PFA.(1) assessment phase; (2) stabilization phase; (3) triage phase; (4) communication phase; and (5) hotline phase.

4.

The response should include the following questions: type of separation from the military, current relationship issues, psychological and physical injuries, exposure and reaction to traumatic events while deployed or at all, and unresolved memories are important questions for crisis counselors to keep in mind when assessing for suicide or homicidal ideation and behaviors.

52 .

Chapter 12: Emergency Preparedness and Response in the Community and Workplace Multiple Choice Questions 1.

According to the Council for Accreditation of Counseling and Related Educational Programs (CACREP) 2016 standards, all master’s level counselors-in-training must have curriculum pertaining to A. the counselors’ roles and responsibilities as members of an interdisciplinary emergency management response team during a regional disaster.

B. effects of crises on persons of all ages.

C. suicide prevention models.

D. All of the above.

2.

Which of the following leadership roles can be found in a Multidisciplinary Crisis Response Team A. media Liaison B. mortality Liaison C. both of the above D. none of the above,

3.

Psychological First Aid (PFA) can be used with A. children only.

B. adults only.

C. the elderly only.

D. All of the above.

4.

Which of the following statements about psychological first aid (PFA) is NOT true?

A. psychological first aid (PFA) is grounded in evidence-based research.

B. psychological first aid (PFA) is less intrusive than critical incident stress management (CISM).

C. psychological first aid (PFA) is more intrusive than critical incident stress management (CISM).

D. psychological first aid (PFA) is rooted in the notion that individuals are resilient.

5.

A mental health clinician practicing psychological first aid (PFA) would be less likely to A. observe the individual before engaging in counseling.

B. provide practical and realistic resources.

C. allow the individual to detail the trauma and vent.

D. empower the individual by letting the individual know that there is hope.

6.

__________ trauma affects a person’s mental and emotional state and requires the person to react to the event in some compensatory manner.

A. placated B. collective C. individual D. stressful

7.

When a disaster strikes, survivors most likely exhibit shock A. when the initial disaster strikes.

B. days after the disaster strikes.

C. months after the disaster strikes.

D. a year after the disaster strikes.

8.

When a disaster strikes, survivors most likely exhibit an attitude of moving on A. when the initial disaster strikes.

B. hours after the disaster strikes.

C. days after the disaster strikes.

D. a year after the disaster strikes.

53 .

9.

When a disaster strikes, mental health clinicians should attempt to reduce the chaos of the disaster A. when the initial disaster strikes.

B. days after the disaster strikes.

C. months after the disaster strikes.

D. a year after the disaster strikes.

10. When a disaster strikes, mental health clinicians should engage in some problem solving interventions A. when the initial disaster strikes.

B. hours after the disaster strikes.

C. days after the disaster strikes.

D. a year after the disaster strikes.

11. Typical responses to a disaster, such as apathy, feelings of being overwhelmed, depression, irritability, anxiety, agitation, panic, and helplessness are called A. cognitive reactions.

B. physical reactions.

C. emotional reactions.

D. behavioral reactions.

12. Typical responses to a disaster such as restlessness, conflicts with others, withdrawal from others, lack of interest in social activities, and increased drug/alcohol use are called A. cognitive reactions.

B. physical reactions.

C. emotional reactions.

D. behavioral reactions.

13. The three essential elements needed to prevent chaos immediately following a disaster include A. connections, communication, and command post B. connections, community outreach, and command post C. connections, communication, and community outreach D. None of the above.

14. __________ has demonstrated effectiveness for individuals who have experienced a crisis.

A. psychological first aid (PFA) B. play therapy C. eye movement desensitization and reprocessing (EMDR) D. all of the above 15. __________ has a specific emphasis on potentiating pairings or venting and debriefing.

A. psychological first aid (PFA) B. critical incident stress management (CISM) C. play therapy D. eye movement desensitization and reprocessing (EMDR) 16. __________ is NOT a component in a crisis counseling program (CCP).

A. assessing strengths B. creating an open door policy C. restoring pre-disaster functioning D. providing validation 17. In a crisis counseling program (CCP), the term “Accept the Face Value” means A. one must identify not only what the problems are, but also what human and material resources are available.

B. the key to restoring life to what it was before the disaster is to attempt to reduce the chaos of the disaster.

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C. the provision of unconditional positive regard, acceptance, and validation is critical to the growth of disaster victims.

D. one must help clients to reorganize life to accommodate for the impact of the disaster.

18. A(n) __________ has a unique psychological toll on survivors because their belongings are not gone but destroyed.

A. flood B. earthquake C. tornado D. wildfire 19. At least _____ of hostage takers have a mental or emotional disorder.

A. 30% B. 40% C. 50% D. 60% 20. During the __________ stage of a typical hostage situation, the hostage taker often becomes suicidal.

A. alarm B. crisis C. accommodation D. resolution 21. During the __________ stage of a typical hostage situation, the hostage taker often feels fatigued.

A. accommodation B. resolution C. Both of the above.

D. None of the above.

22. During the __________ stage of a typical hostage situation, hostages would be most traumatized.

A. alarm B. crisis C. accommodation D. resolution

Extended Response Questions 1.

What might be some important issues to keep in mind when responding to an earthquake? How might this be different from responding to a school shooting?

2.

Describe the essential four stages of a hostage situation. At each stage, what are important things to keep in mind as a mental health clinician?

3.

Identify the differences between Psychological First Aid (PFA) and Critical Incident Stress Management (CISM). Also, provide insight into which of these models you prefer and explain why.

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Multiple Choice Answer Key: 1. D 2. C 3. D 4. B 5. C 6. C 7. D 8. A 9. A 10. B 11. C 12. D 13. A 14. D 15. B 16. B 17. D 18. A 19. C 20. D 21. C 22. A

Feedback for the essay question: 1.

The response could include information on the following: discussion on the differences between “man-made disasters” and “God-made disasters”. Often, blame on others in man-made disasters may bring about anger and answers but God-made disasters may impact spiritual and religious beliefs which can impact supports. Earthquake and other God-made disasters may require crisis workers to focus on basic needs of shelter, food, and relocation. In man-made disasters, such as shooting, crisis workers may need to focus on perceived safety issues as the priority.

2.

The response should include information on the following: five stages of a hostage situation: (1) alarm, (2) crisis, (3) uncertainty, (4) accommodation, and (5) resolution. Each stage encompasses certain issues for mental health worker in order to understand the issues experienced by a client at each stage. For example, during the crisis stage, victims may form a relationship with the hostage taker and if there are injuries to others, then guilt may be need to be assessed. Information to the victims regarding common reactions for survival strategy may need to be reported to the client.

3.

The response should include information on the following: PFA:(1) assessment phase; (2) stabilization phase; (3) triage phase; (4) communication phase; and (5) hotline phase.

CISM: Introduction Phase: setting the rules and tone of discussion; Fact Phase: discussion of what happened during the crisis from each person’s perspective; Thought Phase: Clients discuss the main emotion and cognition they experienced while going through the crisis; Reaction Phase: Clients discuss the worst part of the crisis; Symptom Phase: Clients describe their symptoms of distress during and after the crisis; Teaching Phase: Teach ways to reduce stressors and the impact of stress; and Re-entry Phase: Counselor answers questions and summarizes comments.

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Chapter 13: Emergency Preparedness and Response in Schools and Universities Multiple Choice Questions 1.

A school’s response to crisis must A. provide accurate information.

B. provide necessary support and services.

C. prevent additional crises stemming from the initial crisis.

D. All of the above.

2.

The U.S. Department of Education’s Office of Safe and Drug-Free Schools (2017) identified four phases of a comprehensive school crisis plan, including all of the following EXCEPT A. mitigation/prevention.

B. preparedness.

C. restoration.

D. response.

3.

According to FEMA, __________ is an action step for mitigation and prevention in schools.

A. knowing the school building B. knowing the community C. conducting regular school safety and security efforts every 5 years D. All of the above.

4.

In attempts to secure the building from outside intruders, schools could A. employ a school resource (security) officer.

B. implement a sign-in procedure.

C. keep entrances to the building locked.

D. All of the above.

5.

__________ refers to the physical, aesthetic, and psychological qualities within a school.

A. School climate B. School social structure C. School character D. None of the above.

6.

School personnel can help foster school climate by A. implementing character education programs.

B. promoting safety and cleanliness of the facilities.

C. implementing bullying prevention programs.

D. All of the above.

7.

According to Kerr (2009), a __________ is a brief written expression of guiding ideas derived from regulations, mandates, or an organization’s philosophy.

A. procedure B. policy C. Both of the above.

D. None of the above.

8.

A crisis plan should be A. shared with only the members of the crisis team.

B. reviewed every 5 to 10 years.

C. implemented quickly and efficiently in a crisis.

D. None of the above.

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9.

The crisis team should include the A. principal.

B. school counselor.

C. school security officer.

D. All of the above.

10. All of the following statements regarding crisis teams are TRUE EXCEPT A. The crisis team should be provided with extensive training that is ongoing.

B. Crisis teams should meet at the beginning of each school year to review procedures.

C. Specific responsibilities should be outlined as each crisis is unfolding.

D. For success, it is critical that the crisis team have the full support of the school administration.

11. In preparation for a crisis, schools should A. provide in-service training for all school staff at the beginning and midpoint of the year.

B. post an outline of emergency procedures on the wall of each classroom.

C. perform disaster/crisis drills.

D. All of the above.

12. A __________ is designed so that district and school crisis teams, first responders, and other community partners come to the table to evaluate whether written plans would work in an emergency. During this activity, a hypothetical scenario is discussed to assess how school and community partners would respond to the situation.

A. disaster drill B. tabletop exercise C. scenario exercise D. fire drill 13. A crisis plan A. should detail exact steps to be taken in the event of a crisis situation.

B. ensures that parents/guardians are informed of the plan prior to any crisis.

C. ensures communications to parents/guardians must be communicated in all languages represented at the school.

D. All of the above.

14. Shelter-in-place may be used when A. there is not time to leave the building.

B. it may be harmful to leave the building.

C. Both of the above.

D. None of the above.

15. During a lockdown A. nobody is permitted to enter or leave the building.

B. classroom doors are locked.

C. Both of the above.

D. None of the above.

16. __________ guidelines refer to actions taken immediately to manage an event which may threaten the safety of all parties with the goal of stopping or minimizing the event. An intruder in the building would be an example of a time when these guidelines would be implemented.

A. Emergency B. Crisis C. Disaster D. None of the above.

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17. According to ASCA, the school counselor takes on a leadership role in the development of a systematic crisis plan and becomes involved in A. prevention efforts.

B. intervention efforts.

C. post-incident support of school critical responses.

D. All of the above.

18. The main goal during the __________ phase is to return the school to a stable, pre-crisis environment and return students to learning as quickly as possible.

A. recovery B. mitigation C. response D. None of the above.

19. During the recovery phase A. school personnel need to keep students, families, and media informed.

B. families and community members must be informed about services provided for students and families at school and in the community.

C. cultural differences should be considered when composing letters or announcements to parents. It may be necessary to provide information in a variety of languages.

D. All of the above.

20. All of the following regarding debriefing are TRUE EXCEPT that A. debriefing is a time for the crisis team members to gather and share their experiences of the crisis in a private and safe environment.

B. support during debriefing is critical for team members because the event may have triggered some other unresolved crisis in their life.

C. Both of the above are true.

D. None of the above are true.

21. Evaluation of the crisis response and recovery efforts is a necessary part of the crisis plan. FEMA (2012) suggests addressing which of the following questions during assessment?

A. Which recovery strategies would you change and why?

B. What additional training is necessary to enable the school and the community at large to prepare for future crises?

C. Which classroom-based interventions proved most successful and why?

D. All of the above.

22. Strategies for helping students during and after a school crisis include A. class meetings.

B. individual and small group counseling.

C. Both of the above.

D. None of the above.

23. When sending a letter to parents/guardians regarding a crisis, it is important to include A. accurate information.

B. symptoms/reactions children may display.

C. services available for students and parents.

D. All of the above.

24. In higher education settings, threat assessment teams A. identify individuals whose behavior causes concern or disruption on or off campus affecting students, faculty, and staff.

B. assess whether the identified individual possesses the intent and ability to carry out an attack against the community, and if the individual has taken steps to prepare for the attack.

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C. Both of the above.

D. None of the above.

25. Colleges and universities prepare and respond to crises by A. making every member of the campus community aware of emergency procedures and crisis plans.

B. developing an alert system (e.g., text, email, website, phone message) to alert students, faculty, and staff to potential emergencies on campus.

C. developing a crisis plan for all situations that could impact the campus.

D. All of the above.

Extended Response Questions 1.

List and discuss the importance of each phase of a comprehensive school crisis plan identified by the U. S. Department of Education’s Office of Safe and Drug –Free Schools (2017).

2.

Discuss the roles of the crisis team and describe their responsibilities.

3.

What is the purpose of the Threat Response Team (TAT)?

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Multiple Choice Answer Key: 1. D 2. C 3. C 4. D 5. D 6. A 7. D 8. B 9. D 10. C 11. D 12. B 13. D 14. C 15. C 16. A 17. D 18. A 19. D 20. A 21. D 22. C 23. D 24. C 25. D

Feedback for the essay question: 1.

The response should include information on the following: the 4 phases are applicable to public and private K-12 schools, community co colleges, and public and private colleges and universities and include: (1) mitigation and prevention, which addresses what schools can do to reduce or eliminate risk to life and property; (2) preparedness, which refers to the process of planning for a crisis; (3) response, which refers to the actions taken during the crisis; and (4) recovery, which refers to restoring the school environment after a crisis.

2.

The response should include information on the following: (1) Crisis team leader: usually the principal or another administrator; (2) Crisis team leader designee: a person who takes over if the team leader is absent; (3) Offsite manager: a senior staff member without direct student responsibilities who can prepare in-shelter facilities in an evacuation; (4) Security coordinator: a school resource officer, security guard, or other staff member who can work with others to secure the school until law enforcement arrives; (5) Medical responder: usually the school nurse or a staff member with medical training; (6) Communications coordinator: someone who manages the communications until the designated spokesperson takes over. This person may need to work with additional individuals who can translate information to be relayed in all languages represented in the school community; (7) Mental health specialist: a school counselor, psychologist, or social worker who is responsible for providing counseling support and services; (8) Facilities manager: a custodian or building manager who can address utility needs, direct traffic, and provide floor plans to public safety responders.

3.

The response should include information on the following: The TAT evaluates persons of concern who may pose a potential risk of violence. The TAT is composed of many persons from various departments across the university. Most TAT’s have a three-step process in threat assessment: (1) Identify individuals whose behavior causes concern or disruption on or off campus affecting students, faculty, or staff; (2) Assess whether the identified individual possesses the intent and ability to carry out an attack against the community, and if the individual has taken steps to prepare for the attack; and (3) Manage the threat posed by the individual, to include disrupting potential plans of attack, mitigating the risk, and implementing strategies to facilitate long-term resolution.

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Chapter 14: Counselor Self-Care in Crisis Situations Multiple Choice Questions 1.Self-assessment is the process whereby counselors A. underestimate best practice.

B. react emotionally to challenges.

C. monitor their reactions, behaviors, and feelings.

D. reject internal process.

2.

In addition to self-check-ins for mental health monitoring, counselors should also A. ask clients for feedback regarding their performance.

B. conceal stress so that they can continue to be role models.

C. disclose their concerns to clients.

D. debrief with colleagues.

3.

Crisis intervention can lead to stress and burnout due to A. the emotionally charged environment.

B. client resiliency.

C. counselor resiliency.

D. wellness training.

4.

Counselor James has unresolved grief about his mother’s untimely death at a young age from breast cancer. His new client has come to counseling for help with facing her diagnosis of breast cancer. James begins to cry during the intake session.

This is an example of A. consultation.

B. countertransference.

C. transference.

D. resolution therapy.

5. __________ occurs when counselors exhaust themselves both physically and emotionally over time.

A. Resiliency B. Compassion empathy C. Burnout D. Vicarious trauma 6. Disconnected counselors have high levels of client A. adjustment.

B. esteem.

C. purpose.

D. devaluation.

7. Secondary traumatic stress refers to A. the ability to cope with primary trauma.

B. behaviors and emotions resulting from trauma stories.

C. cognitive burnout.

D. stress emphasis.

8. __________ involves a changed worldview and sense of self as a result of work with trauma clients.

A. burnout B. secondary traumatic stress C. compassion fatigue D. vicarious trauma 62 .

9. While burnout is a response to occupational stress, vicarious trauma involves a personal __________ reaction to a client’s experience.

A. behavioral B. affective C. cognitive D. emotional 10. __________ occurs when counselors experience affirming thoughts, feelings and beliefs after hearing about clients’ adaptation to difficulties.

A. vicarious resiliency B. internal stress C. vicarious trauma D. empowerment burnout 11. All of the following are examples of vicarious trauma prevention EXCEPT A. peer supervision.

B. training and education on trauma work.

C. overtime to gain experience working with trauma clients.

D. spirituality.

12. Counselors working with __________ must be especially intentional about self-care.

A. the elderly B. adolescents C. a wide spectrum of client issues D. trauma clients 5.

The capacity of clients to deal with trauma and restore their lives was found to be __________ to counselors.

A. empowering B. overwhelming C. insignificant D. detrimental

6.

Counselor well-being is dependent upon __________ to engage in self-care.

A. external pressure B. enforced requirements C. intentional choices D. professional organizations

15. Self-care is considered a ________ factor in the counseling profession: A. risk B. protective C. transference D. none of the above 16. Example of issues leading to burnout are A. compensation and hours of work B. compensation and working with a large caseload of trauma victims C. working with a large caseload of trauma victims and hours of work D. working with a large caseload of trauma victims and lack of experience in the field 17. The Professional Quality of Life Scale (ProQOL) is a measure of compassion satisfaction and fatigue that provides the counselor with a score for: A. compassion satisfaction, burnout, and vicarious trauma B. compassion satisfaction, burnout, and secondary traumatic stress C. compassion satisfaction, vicarious trauma, and secondary traumatic stress D. vicarious trauma, burnout, and secondary traumatic stress 63 .

18. Secondary Traumatic Stress is most associated with the concept of: A. Vicarious Trauma B. Job Satisfaction C. Compassion Fatigue D. Burnout 19. Vicarious trauma involves a personal _____ reaction within the counselor to a client’s experience.

A. Cognitive B. Behavioral C. Interpersonal D. Intrapersonal 20. _____ is a new concept used to describe when counselors are affected adversely by trauma work and can experience affirmative thoughts, feelings and beliefs through hearing their clients’ stories.

A. Positive reinforcement B. Learned helpfulness C. Vicarious resiliency D. Compassion inclusion

Extended Response Questions: 1. Discuss the ethical obligation for engaging in self-assessment and self-care.

2. Define and discuss the differences between burnout, compassion fatigue and vicarious trauma.

3. Discuss the steps a counselor/agency should take to decrease the vicarious trauma

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Multiple Choice Answer Key: 1. D 2. D 3. A 4. B 5. C 6. D 7. B 8. D 9. C 10. A 11. C 12. D 13. A 14. C 15. B 16. A 17. B 18. C 19. A 20. C

Feedback for the essay question: 1.

The response should include information on the following: ethical codes are built into professional practice to protect the public. Specifically, ethical codes provide a framework to assist counselors and supervisors in decreasing burnout and vicarious trauma and increasing resiliency, wellness, and sustainability when working with trauma, crisis situations/populations, and difficult clients.

2.

The response should include information on the following: Burnout is related to job satisfaction/dissatisfaction. And other chronic interpersonal job related aspects of the position (working conditions). Types of counselors who may experience burnout include well-adjusted counselors, persevering counselors, and disconnected counselors.

Compassion fatigue may be experiences after counselors are exposed to client pain and suffering through listening to telling their stories. Compassion fatigue differs from burnout in that burnout is connected to working conditions and compassion fatigue is associated with in identification with the client and their trauma. Vicarious trauma may be experienced when exposure to the trauma stories of the client triggers pervasive alterations in a counselor’s cognitive schema, resulting in disruptions to the counselor’s sense of safety, trust, esteem, control, and intimacy.

3.

The response should include information on the following: (1) case management specifically limiting the number of trauma clients per week as much as possible; (2) peer supervision, which provides an avenue for debriefing and consultation; (3) agencies assuming responsibility to provide supervision, consultation, staffing, continuing education, and employee benefits, including personal counseling; (4) training and education on trauma work; (5) personal coping mechanisms, which include leisure activities and creative endeavors; and (6) spirituality to facilitate connection and meaning.

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