NCE practice test, every option explained

A group member has said little for three sessions and looks down whenever others discuss anxiety. Which leader skill is MOST appropriate?

1. Blocking
   Blocking stops harmful behavior such as attacking, gossip, or breaking confidentiality; silence harms no one and needs an invitation instead.
2. Cutting off
   Cutting off stops a member who rambles or monopolizes; this member is barely speaking.
3. Drawing out
   Drawing out invites quiet or withdrawn members to share, for example by gently asking what she notices while others talk about anxiety.

A counselor says, "I wonder whether the anger you feel toward your boss is partly anger you could never express toward your father." Which skill is the counselor using?

1. Reflection of feeling
   A reflection names the feeling within the client's own frame; linking it to his father adds meaning the client never stated.
2. Immediacy
   Immediacy addresses what is happening between counselor and client in the session itself; this response links his anger to his past instead.
3. Interpretation
   Interpretation offers a new frame of reference beyond what the client said, here linking anger at the boss to unexpressed anger at his father.
4. Confrontation
   Confrontation points out a discrepancy, such as between words and actions; the counselor is offering a hypothesis about origins instead.

Parents who are warm and accepting but make few demands and rarely enforce rules illustrate which parenting style?

1. permissive (indulgent)
   Baumrind's permissive parents are high in warmth and responsiveness but low in demands and rule enforcement.
2. authoritarian
   Authoritarian parents are high in demands and low in warmth, the reverse of the pattern described.
3. uninvolved (neglectful)
   Uninvolved parents are low in both warmth and demands; these parents are warm and accepting.

Before giving a client a self-scored career inventory, the counselor learns that the client reads at about a fourth-grade level. What should the counselor do?

1. Skip assessment and rely only on the interview
   Dropping assessment entirely discards useful information when a suitable instrument exists.
2. Read the items aloud without noting the change in procedure
   Reading items aloud changes standard administration, and leaving it unrecorded hides a departure that affects how the scores can be used.
3. Choose an instrument that matches the client's literacy
   Counselors choose instruments that fit the client; an inventory the client cannot read gives invalid scores however carefully they are interpreted.
4. Administer the inventory as planned and interpret cautiously
   Caution in interpretation cannot rescue scores from items the client could not read; the problem is in the administration itself.

A panel of experts checks whether a certification exam's items proportionally cover every knowledge area in the job analysis. Which source of validity evidence is this?

1. response processes
   Evidence based on response processes examines how test takers actually think while answering, for example through think-aloud studies, not expert review of domain coverage.
2. consequences of score use
   Evidence based on the consequences of score use looks at intended and unintended effects of using the scores, such as adverse impact, not how well the items sample the domain.
3. test content
   Evidence based on test content is the judgment that the items represent the domain, here expert review of coverage against the job analysis, one of the five sources of validity evidence in the 2014 AERA/APA/NCME Standards.

A state licensure exam passes every candidate who answers at least 85% of items correctly, no matter how other candidates score. What kind of test is this?

1. Norm-referenced
   A norm-referenced test ranks people against a comparison group, so whether a candidate passes would depend on others' scores.
2. Percentile-ranked scoring
   A percentile rank shows standing relative to a norm group, the opposite of a fixed 85 % standard.
3. Criterion-referenced
   A criterion-referenced test compares each candidate with a fixed standard, so everyone above the cut passes regardless of how others score.
4. Ipsative
   Ipsative scores compare a person's own scores with one another, such as preferences in a forced-choice inventory, not with a standard.

A new depression scale gives nearly identical scores each time it is taken, but its scores do not correlate with other established depression measures. What can the counselor conclude?

1. It is neither reliable nor valid
   Nearly identical scores across administrations are evidence of reliability, so calling it unreliable ignores the data.
2. It is reliable but lacks validity evidence
   Consistent scores show reliability, but failing to correlate with established depression measures leaves the scale without convergent validity evidence.
3. It is valid but has low reliability
   This reverses the findings: the scores are consistent (reliable) and it is validity evidence that is missing.
4. It is both reliable and valid
   Reliability is necessary but not sufficient for validity; consistent scores alone do not show the scale measures depression.

In Krumboltz's social learning theory of career decision making, a client's habits of setting goals, gathering occupational information, and weighing alternatives are called

1. self-observation generalizations
   Self-observation generalizations are conclusions people draw about their own interests and abilities, not their decision-making habits.
2. worldview generalizations
   Worldview generalizations are beliefs about how the world and occupations work, not skills for deciding.
3. task-approach skills
   Krumboltz called the learned habits people bring to decisions, such as goal setting, gathering information, and weighing options, task-approach skills.
4. instrumental learning experiences
   Instrumental learning experiences are past actions and their consequences that shape preferences; the decision habits that result are task-approach skills.

A 7-year-old boy tells his school counselor he will never be a nurse because "that's a girl's job." In Gottfredson's theory of circumscription and compromise, this reflects which stage?

1. Orientation to social valuation
   From about 9 to 13, children rule out jobs by social class and prestige; this 7-year-old is sorting by gender.
2. Orientation to size and power
   At about 3 to 5, children think of jobs in terms of size and power, adult versus child, before gender sorting begins.
3. Orientation to the internal, unique self
   From about 14, adolescents weigh their own interests and values, well after the gender-based rejection described.
4. Orientation to sex roles
   From about 6 to 8, Gottfredson's orientation to sex roles leads children to rule out jobs they see as wrong for their gender, as with 'that's a girl's job.'

A counselor encourages a client to stay curious, take small risks, and turn unexpected events into career opportunities. Which approach is the counselor using?

1. Krumboltz's planned happenstance
   Planned happenstance teaches curiosity, persistence, flexibility, optimism, and risk-taking so clients create and act on unplanned events.
2. Parsons' trait-and-factor matching
   Trait-and-factor matching fits known traits to known job requirements; it does not try to turn chance events into opportunities.
3. Cognitive information processing
   Cognitive information processing teaches a structured decision cycle (CASVE) and examines negative career thoughts, not openness to chance.
4. The theory of work adjustment
   The theory of work adjustment explains satisfaction and tenure through the fit between a worker's needs and abilities and the job's reinforcers and requirements.

A client describes weeks in which her partner grows increasingly irritable and critical, and she walks on eggshells trying to keep him calm, before an explosion of violence. In Walker's cycle of violence, she is describing which phase?

1. Acute battering incident
   The acute battering incident is the explosion itself; she is describing the weeks leading up to it.
2. Tension-building phase
   Walker's tension-building phase brings rising irritability and minor incidents while the victim tries to keep the abuser calm.
3. Reconciliation phase
   Reconciliation is a later label for the post-violence apology phase, not the buildup of tension.
4. Honeymoon phase
   The honeymoon (loving contrition) phase follows the violence, with apologies and promises; she is describing the buildup before it.

A client has not used alcohol for 8 months and is now focused on avoiding relapse during holidays and stressful weeks. Which stage of change is the client in?

1. Maintenance
   In the transtheoretical model, maintenance begins after about 6 months of sustained change and focuses on preventing relapse.
2. Preparation
   Preparation comes before the change, when a person plans to act soon; this client has already changed.
3. Action
   Action covers roughly the first 6 months of new behavior; at 8 months of abstinence the client has moved into maintenance.
4. Termination
   Termination means no temptation and complete confidence; worrying about holiday relapse shows the client is not there.

After a widely publicized celebrity suicide that was reported in detail, suicide rates rise in the following weeks, especially among young people. What is this phenomenon called?

1. Diffusion of responsibility
   Diffusion of responsibility explains why bystanders in a group fail to help, unrelated to media effects on suicide.
2. Postvention
   Postvention is the support offered after a suicide to reduce harm among survivors, not the rise in suicides itself.
3. Survivor guilt
   Survivor guilt is a grief reaction of people close to someone who died, not a population-level rise in suicide.
4. Contagion effect
   The contagion effect (Werther effect) is a rise in suicidal behavior after exposure to suicide, especially with detailed or sensational coverage, which is why safe-messaging guidelines exist.

A client with OCD believes that merely imagining her child being hurt makes it more likely to happen, and that the image is as bad as acting on it. This belief is called

1. emotional reasoning
   Emotional reasoning treats a feeling as proof ('I feel guilty, so I did wrong'); she treats a thought as causing harm.
2. catastrophic misinterpretation
   Catastrophic misinterpretation is Clark's panic mechanism of misreading body sensations as signs of disaster.
3. thought-action fusion
   Thought-action fusion is the belief that thinking something makes it likelier or is morally equal to doing it, a belief that fuels distress in OCD.
4. mind reading
   Mind reading is assuming one knows what others think; her belief is about the power of her own thoughts.

A 50-year-old with a family history of colon cancer refuses screening, saying, "People like me don't get cancer." In the health belief model, which factor is MOST clearly limiting his action?

1. Perceived barriers
   Barriers are the costs of acting, such as discomfort or price; he does not mention any obstacle to screening.
2. Self-efficacy
   Self-efficacy is confidence in one's ability to take the action; his doubt is about being at risk, not about getting screened.
3. Perceived severity of cancer
   He does not deny that cancer is serious; he denies that it could happen to him.
4. Perceived susceptibility
   In the health belief model, perceived susceptibility is a person's belief that he is at risk; 'people like me don't get cancer' shows it is low.

A client who had stayed sober for more than a year relapses and now says he is thinking about trying to quit again. How does the transtheoretical model view this?

1. Recycling through earlier stages is common
   Prochaska and DiClemente describe change as cyclical: relapse is common, and people usually recycle to an earlier stage and learn from each attempt.
2. The relapse shows the treatment has failed
   Relapse is expected in the model, not proof that treatment failed; most people cycle through the stages several times before lasting change.
3. The model no longer applies to this client
   Relapse is built into the model; it does not make the model inapplicable.
4. The client must restart at precontemplation
   Restarting at precontemplation is not required: he already plans to try again, which is contemplation or preparation.

A client stops taking paroxetine abruptly. Within a few days she has dizziness, flu-like aches, irritability, and brief "electric shock" sensations in her head. What is the MOST likely explanation?

1. Antidepressant discontinuation syndrome
   Antidepressant discontinuation syndrome follows stopping an SSRI abruptly, especially short half-life paroxetine: dizziness, flu-like aches, irritability, and 'brain zaps' within days.
2. Relapse of the original major depressive disorder
   Relapse develops over weeks and does not cause electric-shock sensations or flu-like aches days after stopping.
3. Neuroleptic malignant syndrome
   Neuroleptic malignant syndrome is a rare, dangerous reaction to antipsychotics with high fever and rigidity, unrelated to stopping paroxetine.
4. Serotonin syndrome
   Serotonin syndrome comes from too much serotonergic activity, such as combining drugs, with agitation, fever, and muscle rigidity, not from stopping a drug.

A client with generalized anxiety disorder is prescribed a medication that is not habit-forming, takes 2 to 4 weeks to work, and is not useful taken as needed. Which medication fits this description?

1. Lorazepam
   Lorazepam is another fast-acting benzodiazepine often used as needed, with dependence risk.
2. Alprazolam
   Alprazolam is a benzodiazepine that works within minutes and can be habit-forming, the opposite of the profile described.
3. Buspirone
   Buspirone is a non-benzodiazepine anxiolytic for GAD with little dependence risk; it needs weeks of daily use and does not relieve acute anxiety.
4. Propranolol
   Propranolol, a beta-blocker, eases physical symptoms such as tremor and is often taken as needed for performance anxiety; it is not a weeks-to-work GAD treatment.

When she feels down, a client repeatedly thinks about why she feels this way and what is wrong with her, without taking any action, and her low mood lasts longer. Nolen-Hoeksema called this

1. worry postponement
   Worry postponement is a CBT technique for setting aside a set worry time, an intervention rather than a description of her style.
2. a ruminative response style
   Nolen-Hoeksema's response styles theory holds that rumination, passively dwelling on one's distress and its causes, prolongs and deepens depression.
3. a distracting response style
   Distraction turns attention to neutral or pleasant activities and tends to shorten low moods, the opposite of what she does.
4. problem-focused coping
   Problem-focused coping takes action on the problem; she thinks repeatedly about her mood without acting.

A counselor uses the 5 A's model with a client who smokes. After asking about tobacco use and advising the client to quit, what is the counselor's NEXT step?

1. Assist the client with a quit plan
   Assisting with a plan comes after the readiness check, and only for a client willing to make an attempt.
2. Advise the client on nicotine replacement
   Medication advice is part of assisting a ready client; the second A, advising to quit, has already been done.
3. Arrange a follow-up contact
   Arranging follow-up is the last step, after assessing and assisting.
4. Assess the client's readiness to quit
   The 5 A's run Ask, Advise, Assess, Assist, Arrange, so after advising, the counselor assesses whether the client is willing to try quitting now.

A depressed client lives 90 miles from the nearest counselor in a small rural town and worries that neighbors will see her car at the clinic. What is the BEST option?

1. Schedule monthly office visits to cut down on her travel
   Monthly visits are too infrequent for depression treatment and still expose her car at the clinic.
2. Suggest a local church support group in place of counseling
   A local group does not solve her fear of being seen and is not a substitute for treatment.
3. Refer her to her primary care doctor for medication only
   Medication alone leaves out counseling she is seeking and that her depression may need.
4. Offer telehealth after confirming she has a private space
   Telehealth addresses distance, provider shortage, and visibility, typical rural barriers, as long as privacy at her end is confirmed.

A college student puts off writing every paper until the night before because anything less than perfect feels like failure to him. In a CBT conceptualization, what MAINLY keeps the procrastination going?

1. His low motivation to study for his courses
   Nothing suggests low motivation; he cares so much about the outcome that he avoids starting.
2. His weak time-management and planning skills
   Planning help may be part of treatment, but weak scheduling does not explain why he waits until the last night; the fear of imperfection does.
3. His dichotomous thinking about performance
   The delay is kept going by dichotomous (all-or-nothing) thinking, where less than perfect equals failure, so avoiding the task protects him from that verdict.
4. Unresolved conflicts with his demanding parents
   Unresolved conflicts with parents are a psychodynamic focus, not the factor a CBT conceptualization sees as keeping the delay going.

A client in recovery from alcohol use disorder wants a medication that causes nausea and flushing if the client drinks. Which medication is this?

1. Disulfiram
   Disulfiram blocks the breakdown of alcohol, so drinking causes nausea, flushing, and palpitations, which deters use.
2. Acamprosate
   Acamprosate eases protracted withdrawal symptoms to support abstinence; it does not produce a reaction to alcohol.
3. Buprenorphine
   Buprenorphine treats opioid use disorder, not alcohol use disorder.
4. Naltrexone
   Naltrexone reduces craving and the rewarding effect of alcohol but causes no unpleasant reaction when the client drinks.

A client describes his week in detail but cannot say what he felt, and he struggles to tell sadness from anger or fatigue. This difficulty identifying and describing his own emotions is called:

1. Anhedonia
   Anhedonia is loss of interest or pleasure; he may enjoy things but cannot name what he feels.
2. Alexithymia
   Alexithymia is difficulty identifying, telling apart, and describing one's own emotions.
3. Flat affect
   Flat affect is an observed lack of emotional expression, which says nothing about whether he can identify his feelings.
4. Emotional dysregulation
   Emotional dysregulation is difficulty managing the intensity of emotions, not difficulty recognizing which emotion is present.

A group member keeps the session on track by summarizing progress and asking the group to reach decisions. In Benne and Sheats' classification, which kind of role is this?

1. Task-oriented role
   Benne and Sheats' task-oriented roles, such as initiator, summarizer, and coordinator, help the group get its work done.
2. Maintenance role
   Maintenance roles, such as encourager or harmonizer, tend relationships and morale rather than moving the work forward.
3. Process role
   Process role is not one of Benne and Sheats' three categories, which are task, maintenance, and self-oriented.
4. Self-oriented role
   Self-oriented (individual) roles, such as blocker or dominator, serve personal needs at the group's expense.

Two members who know each other outside the group start sitting together, whispering, and backing each other in every disagreement. What should the leader do?

1. Raise the subgroup openly as a group issue
   Subgroups that act as a bloc undermine trust, so the leader brings the pattern into the open for the whole group to explore.
2. Meet privately with the pair to reprimand them
   A private reprimand creates a secret between the leader and two members and keeps the issue out of the group.
3. Ask one of the two members to leave the group
   Removing a member is punitive and skips exploring a pattern the group can learn from.
4. Ignore it as harmless friendship
   Whispering and voting as a bloc are already affecting the group, so ignoring them lets mistrust grow.

A hospital task force wants its meetings to stay harmonious. Members keep their doubts to themselves, agree quickly with the chair's plan, and never weigh alternatives. Which group phenomenon is this?

1. Groupthink
   Janis described groupthink as the drive for harmony overriding realistic appraisal: doubts are self-censored and alternatives go unexamined.
2. Group cohesiveness
   Cohesiveness often sets the stage for groupthink, but on its own it is healthy; the defining problem here is the suppression of doubts.
3. Social loafing
   Social loafing is reduced individual effort in a group, not quick agreement with the chair.
4. Risky shift
   Risky shift is a group choosing riskier options than members would alone; the problem here is suppressed dissent.

A counselor runs a group for adolescents already diagnosed with depression to reduce impairment and prevent relapse. Which level of prevention does this group represent?

1. Tertiary prevention
   Tertiary prevention works with people who already have a disorder to limit impairment and prevent relapse.
2. Primary prevention
   Primary prevention acts before a problem starts; these adolescents are already diagnosed.
3. Secondary prevention
   Secondary prevention is early identification of emerging problems, such as screening; the diagnosis here is established.
4. Universal prevention
   Universal prevention targets a whole population regardless of risk, not a group selected for an existing diagnosis.

A client says, "I've applied to twelve jobs and haven't heard back from any of them." The counselor responds, "You've sent out a lot of applications and gotten no replies." Which skill is this?

1. Paraphrasing
   A paraphrase restates the content of what the client said in fresh words, without naming a feeling.
2. Summarizing
   A summary pulls together material from a longer stretch of the session, not one statement.
3. Encouraging
   Encouragers are brief prompts such as nods or 'uh-huh'; this is a full restatement of content.
4. Reflection of feeling
   A reflection of feeling would name an emotion such as discouragement; this response stays with the facts.

A school counselor meets with a teacher to help the teacher manage a student's disruptive classroom behavior; the counselor never works with the student directly. This activity is BEST described as

1. mentoring
   Mentoring is a longer-term relationship supporting someone's overall development, not focused help with one student's behavior.
2. clinical supervision
   Supervision is an evaluative, hierarchical relationship within the same profession; the counselor has no authority over the teacher.
3. counseling
   Counseling would be direct work with the student, which the counselor never does here.
4. consultation
   Consultation is a triadic relationship: the counselor helps a consultee (the teacher) work more effectively with a third party (the student).

A counselor notices a client's gestures, facial expressions, posture, and foot tapping. Which category of nonverbal behavior is the counselor observing?

1. Chronemics
   Chronemics concerns the use of time, such as lateness or pacing of speech, not body movement.
2. Paralanguage
   Paralanguage covers vocal qualities such as tone, pitch, and pauses, not gestures or posture.
3. Kinesics
   Kinesics is body movement as communication: gestures, facial expressions, posture, and fidgeting such as foot tapping.

A child's teacher and parents meet to coordinate a plan for the child's classroom behavior. In Bronfenbrenner's model, this interaction BEST illustrates which system?

1. Exosystem
   The exosystem holds settings the child is not part of, such as a parent's workplace, that still affect the child.
2. Mesosystem
   The mesosystem is the set of links between a child's microsystems, such as parents and teachers working together.
3. Microsystem
   Home and school are each microsystems; the interaction between them is the mesosystem.
4. Chronosystem
   The chronosystem is change over time, such as a divorce or historical events, not a meeting between settings.

Which statement reflects Vygotsky's view of learning and development, in contrast to Piaget's?

1. Development must be complete before learning
   Requiring a developmental stage before learning is Piaget's position, the contrast the question asks about.
2. Learning with others can pull development forward
   Vygotsky argued that learning with a more knowledgeable other can run ahead of and drive development, which is the logic of the zone of proximal development.
3. Children build knowledge mainly on their own
   The child as an independent explorer is Piaget's view; Vygotsky stressed social interaction.
4. Thought develops first and language follows it
   Vygotsky saw language as shaping thought, eventually becoming inner speech; thought first is closer to Piaget.

A client with a strong family history of depression developed major depression only after losing his job and his marriage in the same year. Which model BEST explains this onset?

1. Learned helplessness model
   Learned helplessness explains depression through expected uncontrollability and does not account for the inherited vulnerability.
2. Biomedical disease model
   A purely biomedical model would not explain why the depression appeared only after major losses.
3. Social learning model
   Social learning explains behavior through modeling and reinforcement, not a vulnerability triggered by stress.
4. Diathesis-stress model
   The diathesis-stress model holds that a vulnerability, such as family history, produces a disorder only when stress is great enough, as with losing a job and marriage.

A counselor's client with severe, persistent depression may benefit from antidepressant medication. To whom should the counselor MOST appropriately refer the client for a medication evaluation?

1. A clinical psychologist
   Psychologists can prescribe only in a few states and only with added training, so they are not the standard referral for a medication evaluation.
2. A psychiatrist or another prescriber
   A medication evaluation goes to a prescriber, such as a psychiatrist, psychiatric nurse practitioner, or primary care physician.
3. A licensed clinical social worker
   Clinical social workers provide psychotherapy and case management but cannot prescribe.
4. The client's pharmacist
   Pharmacists dispense and advise on medications but do not diagnose or decide whether a client needs an antidepressant.

A counselor with a large trauma caseload wants to reduce her risk of vicarious traumatization. Which strategy is MOST effective?

1. Avoid accepting any new clients who have trauma
   Refusing all trauma clients abandons a population she is trained to serve and is not a realistic protection.
2. Work longer hours to build her trauma expertise
   Longer hours increase exposure and fatigue, which raises the risk she is trying to reduce.
3. Limit her empathy for trauma clients' accounts
   Empathy is central to effective trauma work; limiting it damages treatment rather than protecting her.
4. Balance the types of cases she sees and use supervision
   Balancing the mix of cases she carries, with regular supervision or consultation and self-care, is the recommended protection against vicarious traumatization.

A counselor gives an anxiety scale before and after a new group program and finds scores improved. Some improvement may come from clients' familiarity with the scale. Which threat to internal validity is this?

1. Instrumentation
   Instrumentation means the measure or raters themselves changed; here the scale stayed the same and the clients changed in their familiarity with it.
2. History
   History is an outside event during the study that affects outcomes, such as a stressful news event.
3. Testing
   Testing is the effect of a pretest on later scores, such as familiarity with the scale's items.
4. Maturation
   Maturation is natural change within people over time, not familiarity with the measure.

An immigrant client has stopped speaking his first language, avoids his ethnic community, and now follows only the customs and health practices of his new country. In Berry's acculturation model, this pattern is

1. marginalization
   Marginalization rejects both cultures; he has fully adopted the new one.
2. assimilation
   In Berry's model, giving up the heritage culture while adopting the host culture is assimilation.
3. integration
   Integration keeps the heritage culture while also taking part in the host culture; he has dropped his first language and community.
4. separation
   Separation holds on to the heritage culture and avoids the host culture, the reverse of his pattern.

A gay client has become angry at the heterosexual world, spends time only with LGBTQ friends, and dismisses straight people as unimportant. In Cass's model, which stage is he in?

1. Identity acceptance
   Acceptance comes before pride: the identity is accepted and contact increases, without the anger at the heterosexual world.
2. Identity pride
   In Cass's model, identity pride brings immersion in the gay community, anger at heterosexual society, and devaluing of straight people.
3. Identity tolerance
   Tolerance is an earlier stage of seeking contact mainly to ease isolation, before the identity is accepted.
4. Identity synthesis
   Synthesis is the final stage, when sexual identity is one integrated part of the self and the us-versus-them view fades.

A researcher interviews counselors about coping with burnout, begins with no hypothesis, and develops an explanatory model from repeated coding of the data. Which qualitative tradition is this?

1. Narrative inquiry
   Narrative inquiry studies the stories individuals tell about their lives, focusing on how they are told rather than on building a theory.
2. Phenomenology
   Phenomenology also relies on interviews but describes the essence of a lived experience rather than building an explanatory theory.
3. Grounded theory
   Grounded theory builds a theory inductively from the data through repeated coding and constant comparison, starting with no hypothesis.
4. Ethnography
   Ethnography studies a cultural group's shared patterns through prolonged immersion in the field, not interviews coded into a theory.

Students chosen for a test-anxiety group because they had the highest anxiety scores show lower scores on retest, even before treatment begins. Which threat explains this?

1. Regression toward the mean
   When people are chosen for extreme scores, measurement error alone pulls their retest scores toward the mean, even with no treatment.
2. Maturation
   Maturation is natural change over time; the drop appears at once on retest, before treatment, and only among those picked for extreme scores.
3. History
   History is an outside event between the two measurements; nothing but the retest separates them here, and only the extreme scorers changed.

Sue, Arredondo, and McDavis (1992) organized competencies around counselor self-awareness, understanding the client's worldview, and what third characteristic?

1. Culturally appropriate intervention strategies
   Sue, Arredondo, and McDavis framed competence as awareness of one's own biases, knowledge of the client's worldview, and skill in culturally appropriate intervention strategies.
2. Advocacy at institutional and public policy levels
   Systemic advocacy was added later, most explicitly in the 2015 MSJCC; it is not the third characteristic of the 1992 competencies.
3. Knowledge of the client's acculturation status
   Acculturation status is part of understanding the client's worldview, the second characteristic, not a separate third one.

Which statement about suicide in the United States is accurate?

1. Asking about suicide raises a client's risk
   Asking directly about suicide does not plant the idea or raise risk, and it often brings relief and opens help.
2. Most suicides happen with no warning signs
   Most people who die by suicide show warning signs beforehand, such as talk of death, hopelessness, or withdrawal.
3. Women attempt more often; men die more often
   Women make more suicide attempts, but men die by suicide about four times as often, partly because they more often use firearms.
4. Women die by suicide more; men attempt more
   This reverses the gender paradox; the attempt and death rates run the other way.

A 7-year-old with no medical problems wets the bed several nights a week. Which intervention has the strongest evidence for this child?

1. Restricting fluids after dinner
   Limiting evening fluids is common advice but does not teach the child to respond to a full bladder and has weak evidence alone.
2. Nondirective play therapy
   Play therapy has no evidence for treating bedwetting in a child without emotional problems.
3. A reward chart for dry nights
   Rewarding dry nights alone rewards something the child cannot yet control and does not build the waking response.
4. A bedwetting alarm used every night
   The bell-and-pad alarm, used nightly, conditions the child to wake to bladder signals and has the best long-term success of the behavioral treatments for bedwetting.

A wife calls her husband's employer to say he has the flu whenever he is too hungover to work. In addiction counseling, this behavior is called

1. scapegoating
   Scapegoating blames one family member for the family's problems; this wife is protecting her husband, not blaming him.
2. triangulation
   Triangulation is drawing a third person into a two-person conflict, a family-systems pattern, not protecting a drinker.
3. enabling
   Enabling shields the drinker from the consequences of drinking, such as covering for missed work, which makes continued use easier.
4. detachment
   Detachment, taught in Al-Anon, is the healthy opposite: caring for oneself and letting the drinker face the consequences.

Using a structured, manual-based approach, a counselor encourages a client with alcohol use disorder to attend AA meetings, find a sponsor, and begin working the first steps. What is this approach called?

1. Motivational enhancement therapy
   Motivational enhancement therapy, tested alongside it, builds the client's own motivation in a few sessions; it does not steer him into AA.
2. Twelve-step facilitation
   Twelve-step facilitation is a manualized professional treatment, tested in Project MATCH, that encourages meeting attendance, a sponsor, and step work.
3. Community reinforcement approach
   The community reinforcement approach makes a sober life more rewarding through work, recreation, and family changes, not through AA engagement.
4. Harm reduction
   Harm reduction lowers the risks of continued use without requiring abstinence, while twelve-step work aims at abstinence.

A client asks her counselor for a letter about her emotional support dog. Under federal law, what can such a letter properly support?

1. Official registration of the dog as a service animal
   There is no official federal registry for service or support animals; online 'registrations' are sold to anyone and do not create legal rights.
2. Free in-cabin flights for the dog on airlines
   Since the 2020 Air Carrier Access Act rule, airlines may treat emotional support animals as pets; this reflects the older rule many clients still remember.
3. A request to keep the dog in no-pet housing
   Under the Fair Housing Act a housing provider must consider a reasonable-accommodation request for an assistance animal, and documentation of a disability-related need from a provider who knows the client can support it.
4. The dog's entry into restaurants and stores
   ADA public-access rights cover service animals, dogs individually trained to do work or perform tasks; emotional support alone does not qualify, so a letter cannot open stores or restaurants.

What does the ACA Code of Ethics (B.4.a) require of counselors regarding confidentiality in group work?

1. Clearly explain the importance and limits of confidentiality
   ACA B.4.a: in group work counselors explain the importance and parameters of confidentiality, and that it cannot be guaranteed among members.
2. Guarantee that all member disclosures will remain private
   Counselors cannot guarantee what other members do outside the group, so a promise of complete privacy misleads.
3. Let members negotiate confidentiality rules among themselves
   Letting members negotiate the rules among themselves hands off the counselor's duty; members may discuss norms, but the counselor explains confidentiality and its limits.

A parent asks a counselor to help change their 15-year-old's sexual orientation. What should the counselor do?

1. Agree, as long as the parent signs the consent form
   A parent's legal authority to consent for a minor does not oblige a counselor to use a practice known to cause harm.
2. Refer the family to a practitioner who offers the service
   Referring to someone who does it hands the same harm to another provider; referral does not cure the ethical problem.
3. Agree only if the teen also gives assent to the work
   The teen's assent does not make a harmful practice acceptable; C.7.c applies whatever the client wants.
4. Decline and explain that these efforts can harm the teen
   ACA C.7.c bars techniques with substantial evidence of harm even when requested; sexual orientation change efforts fit that description, and many states ban them for minors.

A year after termination, a former client invites the counselor to invest in her new business. According to the ACA Code of Ethics, how should the counselor decide?

1. Accept if the investment stays under a fixed dollar amount
   The code sets no dollar threshold; the question is risk of harm or exploitation, not the amount.
2. Avoid it if the interaction could harm the client
   ACA A.6.e covers nonromantic relationships with former clients: counselors avoid them when the interaction is potentially harmful, with no fixed waiting period.
3. Wait the required 5 years, then accept freely
   Waiting 5 years borrows the rule for romantic or sexual relationships with former clients (A.5.c); no waiting period applies to business dealings.

A counselor educator is attracted to a student currently enrolled in her program's course. According to the ACA Code of Ethics, what applies?

1. A relationship is allowed if the student initiates it
   The power difference is the reason for the rule, and who initiates does not change it.
2. A romantic relationship is prohibited while she has authority
   ACA F.10.a prohibits sexual or romantic relationships between counselor educators and students currently enrolled in the program over whom they have power and authority.
3. A relationship is allowed if it is documented in writing beforehand
   Documentation applies to boundary extensions, not to romance with current students, which no paperwork makes acceptable.

A counselor's outcome study finds that her agency's flagship program is ineffective. According to the ACA Code of Ethics, what should she do with the results?

1. Report only the favorable secondary findings
   Selective reporting distorts the record as much as withholding; reporting must be accurate and complete (G.4.a).
2. Withhold them until the program can be improved
   Delaying publication until the program improves is still suppression; unfavorable results are reported as they are.
3. Report them even though they reflect unfavorably
   ACA G.4.b: results of professional value are reported, and results unfavorable to institutions or programs are not withheld.

A counselor gives a test whose norm group did not include clients like the person tested. According to the ACA Code of Ethics, what should the counselor do when reporting the results?

1. State reservations about the norms' appropriateness
   ACA E.9.a: counselors include reservations about validity or reliability, including norms that do not fit the person tested (see also E.8).
2. Discard the results without informing the client
   Discarding the results silently withholds information from the client; the remedy is qualified reporting, not erasing the test.
3. Report the scores exactly as if the norms fully apply
   Reporting as if the norms fit hides a known limit and invites misinterpretation of the scores.

An Adlerian counselor points out the hidden payoff of a client's constant helplessness so that the behavior loses its appeal. Which technique is this?

1. Spitting in the soup
   Spitting in the soup exposes the hidden payoff of a behavior; once the client sees it, the behavior is harder to keep up.
2. Acting as if
   Acting as if asks the client to behave as though she already were the person she wants to be; it builds a new behavior rather than spoiling an old one.
3. Push-button technique
   The push-button technique has the client recall pleasant and unpleasant memories to see that she can choose her feelings; it does not target a payoff.
4. Catching oneself
   Catching oneself teaches the client to notice the old pattern as it starts; it is self-monitoring, not the counselor naming the payoff.

Which theorist developed the ABCDE model, in which the counselor actively disputes a client's "musts" and "shoulds"?

1. Aaron Beck
   Aaron Beck's cognitive therapy tests automatic thoughts through collaborative questioning rather than disputing 'musts'; the two are the most common mix-up.
2. Donald Meichenbaum
   Donald Meichenbaum developed cognitive behavior modification and stress inoculation, centered on self-talk, not the ABCDE model.
3. William Glasser
   William Glasser founded reality and choice therapy, built on basic needs and responsible choices, not belief disputing.
4. Albert Ellis
   Albert Ellis developed REBT and its ABCDE model; disputing demanding 'musts' and 'shoulds' is its core technique.

A residential program gives clients points for completing chores, which they later exchange for privileges. Which behavioral technique is this?

1. Premack principle
   The Premack principle uses a preferred activity as the reward for a less preferred one, with no tokens in between.
2. Token economy
   A token economy gives points or tokens for target behaviors that are later exchanged for privileges.
3. Response cost
   Response cost removes tokens or privileges after a problem behavior; this program awards points.

A client's headache ends each time he leaves a stressful family gathering early, and he leaves early more and more often. Which process explains the increase?

1. Negative reinforcement
   Negative reinforcement fits: leaving removes the headache, an aversive state, so leaving early becomes more frequent.
2. Positive punishment
   Punishment decreases a behavior; leaving early is increasing, so punishment cannot explain it.
3. Positive reinforcement
   Positive reinforcement adds something pleasant after a behavior; here something unpleasant is taken away.

A solution-focused counselor asks, 'When was the last time you and your son got through dinner without arguing?' What type of question is this?

1. Circular question
   Circular questions come from Milan systemic family therapy and ask about relationships and differences among members; they are not solution-focused exception seeking.
2. Exception question
   An exception question asks about a time the problem did not happen, here a dinner without arguing, to find what was different.
3. Relationship question
   A relationship question asks how someone else would see the client or change; this asks about a time without the problem.

A client has a rewarding career and many friends, but he ends every romantic relationship as soon as it becomes serious. Which of Adler's life tasks is he struggling with?

1. Friendship
   Friendship is also going well (many friends); the difficulty is in intimate relationships.
2. Self
   The self task, added by later Adlerians, concerns getting along with oneself; the stem points specifically to romantic commitment.
3. Love
   Adler's life task of love covers intimate partnership; ending every relationship once it becomes serious points there.
4. Work
   Work is going well for this client (a rewarding career), so it is not the struggling task.

A first-year student works three part-time jobs and takes on more than he can handle. His parents taught him that he was valuable only when he excelled, and he still feels he must prove his worth. Which Adlerian concept BEST explains his overwork?

1. A fixation from the oral stage
   Oral fixation is a Freudian psychosexual concept, not Adlerian, and does not fit striving to prove worth.
2. An excess of social interest
   Social interest is concern for others and the community; overwork driven by proving worth is the opposite, a self-focused striving.
3. His position in the family constellation
   Family position shapes lifestyle, but the stem says nothing about siblings or birth order; it describes conditional worth.
4. Compensation for feelings of inferiority
   Adler held that people strive to overcome felt inferiority; a student taught that he is valuable only when he excels compensates by overworking.