Human Growth & Development

Question 1

Clients with schizoid personality disorder typically:

• A. Crave attention and social stimulation.
• B. Engage in manipulative behavior to meet their needs.
• C. Show little interest in relationships and prefer solitude.
• D. Fear abandonment and rely on reassurance.

Answer 1

C. Show little interest in relationships and prefer solitude.

Schizoid clients are emotionally detached and prefer solitary activities. Their interpersonal aloofness is ego-syntonic.

Question 2

A 24-year-old man is preoccupied with the idea that his genitals are shrinking and will disappear into his abdomen. He is otherwise functioning normally. Which diagnosis is most consistent?

• A. Somatic Symptom Disorder
• B. Delusional Disorder, Somatic Type
• C. Illness Anxiety Disorder
• D. Body Dysmorphic Disorder

Answer 2

B. Delusional Disorder, Somatic Type

Question 3

A client with paranoid personality disorder avoids eye contact and accuses the counselor of conspiring with family members. What is the MOST therapeutic approach?

• A. Confront the delusion directly with evidence.
• B. Offer vague reassurances to de-escalate.
• C. Maintain a neutral tone and clarify boundaries.
• D. Recommend hospitalization for delusional thinking.

Answer 3

C. Maintain a neutral tone and clarify boundaries.

Maintaining a neutral, structured, and clear therapeutic stance helps reduce mistrust while avoiding unnecessary escalation.

Question 4

A client who prides themselves on environmental activism regularly flies for leisure travel. Which cognitive strategy would most likely reduce their dissonance without changing behavior?

• A. Stopping all air travel
• B. Minimizing the environmental impact of their travel
• C. Increasing their commitment to activism in other areas
• D. Publicly disclosing their hypocrisy to reduce guilt

Answer 4

C. Increasing their commitment to activism in other areas

This is an example of adding consonant cognitions. By amplifying efforts elsewhere, the client justifies the contradictory behavior, reducing discomfort.

Question 5

A 52-year-old man insists that he is destined to marry a famous actress he has never met. He writes her letters weekly and travels to events to try to see her. He functions normally otherwise. Which diagnosis is most consistent?

• A. Erotomanic Type Delusional Disorder
• B. Schizophrenia
• C. Schizotypal Personality Disorder
• D. Obsessive-Compulsive Disorder

Answer 5

A. Erotomanic Type Delusional Disorder

Question 6

A 72-year-old woman becomes disoriented over hours, is unable to sustain attention, and has vivid visual hallucinations. Her family says she was normal yesterday. Which diagnosis is most consistent?

• A. Major Neurocognitive Disorder due to Alzheimer’s Disease
• B. Delirium
• C. Brief Psychotic Disorder
• D. Schizoaffective Disorder

Answer 6

B. Delirium

Question 7

A 34-year-old man reports intrusive, distressing thoughts about contaminating others with germs. He washes his hands for hours daily to relieve the anxiety. He knows the behavior is excessive but cannot stop. Which diagnosis is most consistent?

• A. Obsessive-Compulsive Disorder
• B. Illness Anxiety Disorder
• C. Obsessive-Compulsive Personality Disorder
• D. Somatic Symptom Disorder

Answer 7

A. Obsessive-Compulsive Disorder

Question 8

A counselor sees a college student experiencing high anxiety over making independent decisions, fearing failure and judgment. Which unresolved stage in Erikson’s model is MOST relevant?

• A. Basic trust vs. mistrust
• B. Autonomy vs. shame and doubt
• C. Initiative vs. guilt
• D. Industry vs. inferiority

Answer 8

B. Autonomy vs. shame and doubt

Failure to resolve autonomy vs. shame and doubt can lead to indecisiveness, fear of failure, and dependence on others for approval.

Question 9

A client with borderline personality disorder cuts themselves after missing a session. What is the MOST therapeutic counselor response?

• A. “You’re just doing this for attention.”
• B. “Let’s review what you felt before and after the behavior.”
• C. “We need to increase your sessions immediately.”
• D. “You’re not allowed to discuss that in therapy.”

Answer 9

B. “Let’s review what you felt before and after the behavior.”

Exploring antecedents to self-harm fosters insight and supports behavior change without reinforcing or dismissing the behavior.

Question 10

A counselor working in a correctional facility helps inmates reduce aggression by reinforcing alternative behaviors like journaling or walking away from conflict. This is known as:

• A. Displacement
• B. Behavior modification
• C. Negative punishment
• D. Systematic desensitization

Answer 10

B. Behavior modification

Behavior modification uses reinforcement to replace maladaptive behaviors with adaptive ones.

Question 11

Which of the following best illustrates stimulus generalization in classical conditioning?

• A. A client stops reacting to a stimulus that used to trigger anxiety.
• B. A child who was afraid of a loud blender also fears the vacuum.
• C. A therapist withholds reinforcement until a behavior is shaped.
• D. A reward is given on a variable schedule to increase behavior.

Answer 11

B. A child who was afraid of a loud blender also fears the vacuum.

Stimulus generalization occurs when a response is elicited by stimuli similar to the original conditioned stimulus.

Question 12

A counselor observes a child’s confusion when learning that not all four-legged animals are dogs and guides the child through questioning until the child develops a new understanding. According to Piaget, what motivational principle drives this learning process?

• A. The zone of proximal development
• B. Cognitive equilibrium, achieved through a balance of assimilation and accommodation
• C. Trust vs. mistrust
• D. Self-transcendence

Answer 12

B. Cognitive equilibrium, achieved through a balance of assimilation and accommodation

Piaget proposed that the desire to understand the world stems from a need for cognitive equilibrium, a balance between what we sense and what we know. When disequilibrium occurs, assimilation and accommodation work together to restore balance.

Question 13

What is a key challenge in treating personality disorders?

• A. The disorders are usually brief and self-limiting
• B. Clients do not benefit from structure
• C. Traits are inflexible and perceived as part of the self
• D. Clients typically overreport symptoms

Answer 13

C. Traits are inflexible and perceived as part of the self

Personality disorders involve rigid, lifelong patterns that are ego-syntonic, making motivation for change more difficult.

Question 14

A 29-year-old man reports a persistent belief for the past year that he has a foul body odor, even though repeated medical evaluations are normal. He avoids social situations out of embarrassment. He recognizes others don’t smell anything, but he remains preoccupied. Which diagnosis is most consistent?

• A. Body Dysmorphic Disorder
• B. Somatic Symptom Disorder
• C. Illness Anxiety Disorder
• D. Delusional Disorder, Somatic Type

Answer 14

D. Delusional Disorder, Somatic Type

Question 15

A person who experiences cognitive dissonance but does not resolve the tension is likely to demonstrate which of the following?

• A. Increased clarity about personal goals
• B. Decreased motivation and higher stress
• C. Improved decision-making and insight
• D. Heightened resilience and self-awareness

Answer 15

B. Decreased motivation and higher stress

Unresolved dissonance often results in chronic discomfort, confusion, and even avoidance, impacting motivation and well-being.

Question 16

A counselor notes that a client demonstrates extreme mood swings, unstable relationships, and identity disturbance. Which personality disorder should be considered?

• A. Narcissistic Personality Disorder
• B. Dependent Personality Disorder
• C. Borderline Personality Disorder
• D. Avoidant Personality Disorder

Answer 16

C. Borderline Personality Disorder

Borderline PD is characterized by emotional instability, impulsivity, fear of abandonment, and a fragile self-image.

Question 17

In contrast to other personality disorders, obsessive-compulsive personality disorder is more likely to be:

• A. Ego-dystonic, resulting in emotional distress.
• B. Ego-syntonic, perceived as part of the individual’s identity.
• C. Triggered by past trauma.
• D. Responsive to benzodiazepine treatment.

Answer 17

B. Ego-syntonic, perceived as part of the individual’s identity.

OCPD is ego-syntonic, meaning the individual sees their perfectionism and control as beneficial, unlike the ego-dystonic obsessions in OCD.

Question 18

When using a token economy in a residential treatment setting, clients earn tokens for positive behavior and exchange them for rewards. This system is an example of:

• A. Classical conditioning
• B. Secondary reinforcement
• C. Negative punishment
• D. Fixed interval reinforcement

Answer 18

B. Secondary reinforcement

Tokens have no inherent value but become reinforcing through association with primary rewards—secondary reinforcers.

Question 19

Which of the following BEST illustrates an ego-dystonic experience in therapy?

• A. “I act like this because it gets me what I want.”
• B. “I don’t like that I get so jealous. It doesn’t feel like me.”
• C. “People need to follow my lead because I know best.”
• D. “There’s nothing wrong with how I handle people.”

Answer 19

B. “I don’t like that I get so jealous. It doesn’t feel like me.”

Ego-dystonic thoughts are experienced as distressing or inconsistent with one’s self-image, often motivating change.

Question 20

A client justifies staying in an unhealthy relationship by saying, “All relationships are hard, and no one’s perfect.” What kind of dissonance reduction is this?

• A. Belief elimination
• B. Projection
• C. Rationalization
• D. Cognitive diffusion

Answer 20

C. Rationalization

The client is using rationalization—offering seemingly logical explanations to justify behavior and reduce psychological tension.

Question 21

A teenager begins to ponder abstract concepts such as justice, freedom, and what society might look like under different ethical systems. She enjoys debating hypothetical scenarios and thinking about global problems she has never directly encountered. Which Piagetian stage is she entering, and what new capacity does it reflect?

• A. Sensorimotor; object permanence
• B. Preoperational; animism
• C. Concrete operational; classification
• D. Formal operational; abstract and hypothetical reasoning

Answer 21

D. Formal operational; abstract and hypothetical reasoning

The formal operational stage (around age 12 and beyond) involves the capacity to think logically about both concrete and abstract events, contemplate possibilities, and apply principles such as freedom and dignity.

Question 22

A 4-year-old in play therapy insists that the moon follows her everywhere. She believes that pouring water from a tall, thin glass into a short, wide glass creates “more water,” and she asks “Why?” endlessly. Which stage and cognitive limitation are you witnessing?

• A. Sensorimotor stage and lack of object permanence
• B. Preoperational stage and inability to conserve or reverse operations
• C. Concrete operational stage and centration
• D. Formal operational stage and abstract reasoning

Answer 22

B. Preoperational stage and inability to conserve or reverse operations

In the preoperational stage (about ages 2–7), children have developed language and symbolic thought but lack logical operations. They generalize illogically, see things as static, and cannot yet understand conservation or reversibility. Their repeated “why” questions reflect a drive to make sense of an illogical world.

Question 23

A client begins exercising regularly after learning about the health risks of their sedentary lifestyle. Which stage of dissonance resolution does this reflect?

• A. Avoidance
• B. Conflict amplification
• C. Behavior change
• D. Displacement

Answer 23

C. Behavior change

This is a classic example of resolving dissonance by modifying behavior to match beliefs.

Question 24

A 32-year-old man describes an intense fear of being in crowded shopping malls or on public transportation because he worries he won’t be able to escape if he feels trapped. He now avoids these places unless accompanied by a trusted friend. Most likely DSM-5 diagnosis?

• A. Social Anxiety Disorder
• B. Agoraphobia
• C. Panic Disorder
• D. Generalized Anxiety Disorder

Answer 24

B. Agoraphobia

Question 25

A 38-year-old woman presents with recurrent, unexpected panic attacks and persistent concern about having more attacks for the past 4 months. She also avoids grocery stores and public buses because she worries she might panic there and be unable to escape. **Which diagnosis is most consistent?** * A. Panic Disorder with Agoraphobia * B. Agoraphobia without History of Panic Disorder * C. Generalized Anxiety Disorder * D. Social Anxiety Disorder

Answer 25

A. Panic Disorder with Agoraphobia

Question 26

A 26-year-old man reports constant worry about multiple life circumstances for the past 8 months, with muscle tension, restlessness, and sleep disturbance. **Which diagnosis is most consistent?** * A. Generalized Anxiety Disorder * B. Persistent Depressive Disorder * C. Adjustment Disorder with Anxiety * D. Social Anxiety Disorder

Answer 26

A. Generalized Anxiety Disorder

Question 27

A 10-year-old girl has repeated episodes of staring into space and being unresponsive for about 15 seconds, several times a day. She quickly resumes activity afterward and is unaware it happened. **Which diagnosis is most consistent?** * A. Absence Seizures * B. ADHD, Inattentive Type * C. Dissociative Amnesia * D. Schizophrenia

Answer 27

A. Absence Seizures

Question 28

A toddler sits in a high-chair, dropping toys repeatedly and patting them against the tray. She mouths, smells, and explores every object at arm’s length. From Piaget’s perspective, which stage best describes her cognitive experience, and **why are these actions significant?** * A. Preoperational, illustrating magical thinking and symbolic play * B. Sensorimotor, showing how sensory exploration and motor practice build schemas * C. Concrete operational, demonstrating reversibility and conservation * D. Formal operational, highlighting abstract reasoning about objects

Answer 28

B. Sensorimotor, showing how sensory exploration and motor practice build schemas ## Footnote During the sensorimotor stage (birth–2 years), children refine their senses and motor skills through active exploration. Dropping and mouthing objects help them build foundational schemas of the physical world.

Question 29

A 19-year-old man has recurrent, unexpected panic attacks and persistent worry about additional attacks for the past 2 months, but no avoidance behavior. **What is the diagnosis?** * A. Agoraphobia * B. Panic Disorder * C. Generalized Anxiety Disorder * D. Social Anxiety Disorder

Answer 29

B. Panic Disorder

Question 30

A nine-year-old solves a conservation of number task easily but struggles with conservation of volume. **Piaget described this unevenness in thinking as:** * A. Horizontal décalage, the gradual development of similar skills at different rates * B. Seriation, the ability to order objects by size * C. Reversibility, the capacity to mentally undo operations * D. Assimilation, integrating new information

Answer 30

A. Horizontal décalage, the gradual development of similar skills at different rates ## Footnote Piaget observed that children’s abilities across conservation tasks do not appear simultaneously; this gradual development is termed horizontal décalage.

Question 31

While playing with clay, a child flattens a ball into a pancake and insists there is now “more clay.” The therapist asks the child to roll it back into a ball and compare the sizes again, but the child remains unconvinced. **Which developmental ability has not yet matured?** * A. Classification by multiple characteristics * B. Reversibility—mentally undoing an action * C. Abstract logical reasoning * D. Assimilation of new schemas

Answer 31

B. Reversibility—mentally undoing an action ## Footnote Reversibility is the ability to mentally reverse an action and understand that the material remains unchanged. It is key to conservation tasks. Preoperational children cannot yet imagine reversing their actions.

Question 32

Which of the following best exemplifies **post-decision dissonance?** * A. A client feels uneasy after choosing one job offer over another with better pay * B. A client refuses to acknowledge any downside of their current relationship * C. A client changes their attitude to match a group opinion * D. A client feels conflicted about violating their cultural beliefs

Answer 32

A. A client feels uneasy after choosing one job offer over another with better pay ## Footnote Post-decision dissonance occurs after making a difficult choice, often resulting in second-guessing or rationalization of the chosen option.

Question 33

A client with borderline traits frequently praises one counselor while devaluing others. **This behavior is BEST understood as:** * A. Projection * B. Splitting * C. Displacement * D. Magical thinking

Answer 33

B. Splitting ## Footnote Splitting is a defense mechanism where individuals see others as all-good or all-bad. It's common in borderline personality disorder.

Question 34

A client with narcissistic personality disorder reacts with rage when given constructive feedback in group. **What is the BEST counselor response?** * A. Avoid giving future feedback to prevent escalation * B. Confront the client on their emotional outburst * C. Acknowledge their distress and gently redirect to group norms * D. Remove the client from the group to regain control

Answer 34

C. Acknowledge their distress and gently redirect to group norms ## Footnote Narcissistic clients have fragile self-esteem. Acknowledging their feelings while redirecting promotes regulation without reinforcing entitlement.

Question 35

A 33-year-old who has not developed a stable sense of identity is **MOST likely to**: * A. Transition smoothly into intimacy vs. isolation * B. Struggle to maintain deep, reciprocal relationships * C. Skip directly to generativity * D. Avoid any form of self-reflection

Answer 35

B. Struggle to maintain deep, reciprocal relationships ## Footnote Erikson’s stages are sequential. Without identity resolution, intimacy is likely to be shallow or avoided entirely.

Question 36

A 9-year-old boy has been defiant toward his teachers for 8 months, refusing to follow instructions and deliberately annoying classmates. He argues with adults and blames others for his mistakes. He has no history of aggression, destruction, theft, or serious rule violations. **Which diagnosis best fits?** * A. Oppositional Defiant Disorder * B. Conduct Disorder * C. ADHD, Combined Presentation * D. Disruptive Mood Dysregulation Disorder

Answer 36

A. Oppositional Defiant Disorder

Question 37

A 41-year-old woman has sudden, purposeful travel away from home with inability to recall her past and confusion about her identity. **What is the diagnosis?** * A. Dissociative Amnesia with Fugue * B. Dissociative Identity Disorder * C. Depersonalization/Derealization Disorder * D. Schizophrenia

Answer 37

A. Dissociative Amnesia with Fugue

Question 38

A client in her thirties avoids family gatherings, stating she “doesn’t know where she belongs.” She changes cities frequently, never stays long enough to develop deep ties, and says she feels “like a visitor” everywhere. According to Erikson, which unresolved stage **explains these patterns?** * A. Trust vs. Mistrust * B. Identity vs. Role Confusion * C. Intimacy vs. Isolation * D. Generativity vs. Stagnation

Answer 38

B. Identity vs. Role Confusion ## Footnote The inability to commit to places, communities, and people is consistent with identity diffusion, which undermines the intimacy tasks of early adulthood.

Question 39

A 30-year-old woman has episodes of sudden, intense fear with palpitations and dizziness. She has begun avoiding public transportation because she fears having an attack there and not being able to escape. **Which diagnosis is most consistent?** * A. Panic Disorder * B. Agoraphobia * C. Panic Disorder with Agoraphobia * D. Social Anxiety Disorder

Answer 39

C. Panic Disorder with Agoraphobia

Question 40

A client receives praise from her therapist every time she practices mindfulness at home. Over time, she begins practicing more frequently. **This is an example of:** * A. Positive reinforcement * B. Negative reinforcement * C. Positive punishment * D. Fixed interval reinforcement

Answer 40

A. Positive reinforcement ## Footnote Praising a behavior to increase its frequency is positive reinforcement.

Question 41

A client reports vague childhood memories but recalls frequent tension between parents during early years. Which concept from Freud’s theory is **MOST relevant?** * A. Infantile amnesia related to repression of emotionally threatening material * B. Regression to earlier psychosexual stages during stressful times * C. Internalization of parental values during latency * D. Displacement of unconscious hostility toward safer targets

Answer 41

A. Infantile amnesia related to repression of emotionally threatening material ## Footnote Freud’s concept of infantile amnesia includes the idea that early, emotionally threatening experiences may be repressed, limiting conscious recall.

Question 42

A 40-year-old client presents with chronic difficulty asserting themselves in relationships, often giving in to avoid conflict. Which psychoanalytic explanation **BEST accounts for this behavior?** * A. Overactive id driving impulsive avoidance of confrontation * B. Weak ego unable to mediate between id impulses and superego demands * C. Overdeveloped superego producing guilt when prioritizing personal needs * D. Fixation at the latency stage limiting social skill development

Answer 42

C. Overdeveloped superego producing guilt when prioritizing personal needs ## Footnote When the superego is overly harsh, individuals may avoid self-assertion to prevent guilt, especially if early moral training was rigid. This is not simply ego weakness but a moral overcontrol issue.

Question 43

A 31-year-old woman experienced a stillbirth 3 weeks ago. Since then, she feels persistently sad, has trouble sleeping, and has lost interest in activities she once enjoyed. Symptoms began within days of the event and have persisted daily. **Which diagnosis is most consistent?** * A. Acute Stress Disorder * B. Major Depressive Disorder * C. Adjustment Disorder with Depressed Mood * D. Persistent Depressive Disorder

Answer 43

C. Adjustment Disorder with Depressed Mood

Question 44

Which of the following behaviors is **MOST consistent with antisocial personality disorder?** * A. Avoiding personal interaction and social events. * B. Demonstrating loyalty and intense interpersonal bonds. * C. Disregarding others’ rights and manipulating without remorse. * D. Expressing extreme fear of abandonment.

Answer 44

C. Disregarding others’ rights and manipulating without remorse. ## Footnote Antisocial clients often show a lack of empathy and violate social norms without guilt, reflecting ego-syntonic traits.

Question 45

A 50-year-old man has experienced non-bizarre beliefs that his neighbor is spying on him through his windows for the past 6 months. No hallucinations or disorganized thought processes are present. **Which diagnosis is most consistent?** * A. Paranoid Personality Disorder * B. Schizophrenia * C. Delusional Disorder, Persecutory Type * D. Schizophreniform Disorder

Answer 45

C. Delusional Disorder, Persecutory Type

Question 46

A counselor notices that a teenager stops attending group sessions after being scolded in front of peers. **This is most clearly an example of:** * A. Positive reinforcement * B. Negative reinforcement * C. Positive punishment * D. Extinction

Answer 46

C. Positive punishment ## Footnote The addition of an aversive stimulus (public scolding) results in a decrease in the behavior (attendance).

Question 47

A client with borderline personality disorder threatens to quit therapy after not receiving an immediate reply to a message. What is the **BEST response?** * A. Apologize and commit to faster replies in the future. * B. Ignore the message to avoid reinforcing attention-seeking. * C. Validate their feelings and reinforce communication boundaries. * D. Allow the client to terminate the relationship as requested.

Answer 47

C. Validate their feelings and reinforce communication boundaries. ## Footnote Therapists must validate emotional responses while maintaining structure to avoid reinforcing impulsive or manipulative behaviors.

Question 48

A 5-year-old boy wets the bed 4 nights per week. He has never had a 6-month period of dryness. **Which diagnosis is most consistent?** * A. Encopresis * B. Primary Enuresis * C. Secondary Enuresis * D. Urinary Tract Infection

Answer 48

B. Primary Enuresis

Question 49

A 46-year-old woman has had at least five periods in the past year where she consumed much more alcohol than intended, was unable to cut down despite trying, and spent a lot of time recovering from hangovers. She reports craving alcohol and that drinking has interfered with her work performance. **Most appropriate DSM-5 diagnosis?** * A. Alcohol Use Disorder, Mild * B. Alcohol Use Disorder, Moderate * C. Alcohol Intoxication * D. Alcohol Dependence

Answer 49

B. Alcohol Use Disorder, Moderate

Question 50

A client with narcissistic traits claims the counselor is “too inexperienced” and demands a supervisor instead. **What is the BEST response?** * A. Refer the client to another clinician * B. Explore the feelings behind the client's reaction * C. Apologize for not meeting expectations * D. Ignore the comment and redirect

Answer 50

B. Explore the feelings behind the client's reaction ## Footnote Exploring the underlying emotion (e.g., vulnerability, disappointment) preserves the therapeutic alliance and models emotional insight.

Question 51

During an assessment, a therapist places five red and three blue wooden beads in front of a four-year-old and asks, “Are there more red beads or more beads altogether?” **The child confidently replies, “More red beads!” What concept best explains this error?** * A. Decentration in the concrete stage * B. Assimilation of new information * C. Centration, focusing on one salient feature * D. Conservation of volume

Answer 51

C. Centration, focusing on one salient feature ## Footnote Young children often fixate on a single aspect (the number of red beads) and cannot consider the whole set simultaneously. This focus on one dimension is called centration.

Question 52

A client with histrionic personality disorder may **MOST likely:** * A. Minimize their accomplishments and isolate * B. Display dramatic emotions and crave approval * C. Hold grudges and show signs of paranoia * D. Demonstrate obsessional fears of contamination

Answer 52

B. Display dramatic emotions and crave approval ## Footnote Histrionic clients exhibit excessive emotionality and attention-seeking behaviors.

Question 53

A 28-year-old client says, “I’ve been a teacher, a travel blogger, and now I’m thinking of joining the military. I still don’t know who I am.” Which intervention would **BEST align with helping her resolve Erikson’s Identity vs. Role Confusion stage?** * A. Assign structured journaling on daily routines to increase stability * B. Facilitate exploration of personal values and long-term goals * C. Recommend avoiding new commitments until she feels settled * D. Encourage her to take a year off work without reflection

Answer 53

B. Facilitate exploration of personal values and long-term goals ## Footnote Guided exploration of values helps integrate past experiences into a coherent identity, which is essential before intimacy and generativity can develop.

Question 54

A client says, “I want to explore careers my parents don’t approve of.” The counselor has strong personal views against the client’s choices. **Ethically, the counselor should**: * A. Share personal opinions to steer the client * B. Maintain neutrality and facilitate the client’s exploration of values * C. Recommend abandoning non-approved careers * D. Refer out immediately without discussion

Answer 54

B. Maintain neutrality and facilitate the client’s exploration of values ## Footnote Ethical practice requires maintaining professional neutrality and supporting the client’s self-exploration without imposing personal biases.

Question 55

A child in therapy receives a gold star on their behavior chart each time they use words instead of hitting. Once they earn five stars, they receive extra game time. **This technique uses:** * A. Classical conditioning * B. Chaining * C. Token economy * D. Fixed interval reinforcement

Answer 55

C. Token economy ## Footnote Token economies use conditioned reinforcers (tokens/stars) to encourage desirable behavior.

Question 56

A client describes a pattern of breaking off relationships before they deepen, stating, “I need to focus on me first.” **Which statement BEST reflects Erikson’s theory?** * A. The client is appropriately prioritizing generativity * B. The client is avoiding intimacy due to unresolved identity issues * C. The client is prematurely entering ego integrity * D. The client is regressing to industry vs. inferiority

Answer 56

B. The client is avoiding intimacy due to unresolved identity issues ## Footnote Difficulty committing to relationships often stems from identity confusion, suggesting the intimacy vs. isolation stage cannot be fully engaged.

Question 57

A 32-year-old marketing professional reports a pattern of switching jobs every 6–12 months. She says she feels restless in each role, fearing “being trapped” if she commits to a long-term position or company. She avoids office friendships, stating she doesn’t “want to get too close.” According to Erikson, which unresolved developmental crisis is **most likely influencing her current challenges?** * A. Autonomy vs. Shame and Doubt * B. Industry vs. Inferiority * C. Identity vs. Role Confusion * D. Generativity vs. Stagnation

Answer 57

C. Identity vs. Role Confusion ## Footnote Frequent shifts in role and reluctance to commit suggest unresolved identity issues from adolescence, which can impair the ability to progress into intimacy and stable adult roles.

Question 58

A 35-year-old says she feels “too old to figure out who I am.” **She is at risk for stagnating in which stage?** * A. Intimacy vs. Isolation * B. Identity vs. Role Confusion * C. Generativity vs. Stagnation * D. Ego Integrity vs. Despair

Answer 58

C. Generativity vs. Stagnation ## Footnote If identity remains unresolved in adulthood, the person may enter middle adulthood without the stability needed for generativity, increasing the risk of stagnation.

Question 59

A counselor works with a 28-year-old client who reports difficulty maintaining romantic relationships, often fearing abandonment when partners travel or spend time apart. Drawing on Freud’s theory, which developmental experience would **MOST likely be explored to understand this pattern?** * A. Early toilet training experiences during the anal stage * B. Early separation experiences from the primary caregiver during the oral stage * C. Peer rejection during the latency period * D. Gender role modeling during the phallic stage

Answer 59

B. Early separation experiences from the primary caregiver during the oral stage ## Footnote Freud proposed that unresolved conflicts in the oral stage, particularly involving separation from the primary love object (mother), can create dependency and fear of loss later in life. While the other stages may influence personality, the fear of abandonment aligns most closely with oral stage fixations.

Question 60

A counselor working with a preschooler notices the child often explains events by attributing feelings and intentions to inanimate objects, such as telling a doll that the sun is “angry” because it is too hot. **Which Piagetian concept does this illustrate, and what broader developmental stage does it belong to?** * A. Animism, common in the preoperational stage’s egocentric thought * B. Object permanence, typical of sensorimotor stage * C. Reversibility, part of concrete operational thinking * D. Seriation, emerging in adolescence

Answer 60

A. Animism, common in the preoperational stage’s egocentric thought ## Footnote Animism, the belief that inanimate objects have thoughts and feelings, is part of the egocentric, symbolic thinking of the preoperational stage. Children attribute their own emotions to objects because they cannot yet differentiate their perspective from that of others.

Question 61

A 35-year-old woman presents with loss of sensation in her left arm after an argument. Neurological exam and imaging are normal. She appears unconcerned about the symptom. **What is the diagnosis?** * A. Somatic Symptom Disorder * B. Illness Anxiety Disorder * C. Conversion Disorder (Functional Neurological Symptom Disorder) * D. Factitious Disorder

Answer 61

C. Conversion Disorder (Functional Neurological Symptom Disorder)

Question 62

Which statement **BEST explains why personality disorders are considered ego-syntonic?** * A. Individuals with personality disorders recognize their behaviors as problematic. * B. Personality disorders cause severe guilt and distress for the individual. * C. The behaviors align with the person's self-image and are not viewed as problematic. * D. Personality disorders often lead to psychotic episodes that require hospitalization.

Answer 62

C. The behaviors align with the person's self-image and are not viewed as problematic.

Question 63

A client insists, “If I can’t be perfect, I’m a total failure.” **This cognitive distortion is MOST typical of:** * A. Schizoid personality disorder * B. Borderline personality disorder * C. Obsessive-compulsive personality disorder * D. Avoidant personality disorder

Answer 63

C. Obsessive-compulsive personality disorder ## Footnote OCPD often involves rigid, black-and-white thinking tied to perfectionism and fear of making mistakes.

Question 64

Clients with **schizotypal personality disorder often experience**: * A. Intense emotional closeness with strangers * B. Detachment from social norms and magical beliefs * C. Rigid conformity and compulsive habits * D. Panic attacks in crowded spaces

Answer 64

B. Detachment from social norms and magical beliefs ## Footnote Schizotypal traits include odd beliefs, social withdrawal, and eccentric behaviors, often tied to magical thinking.

Question 65

What **distinguishes** obsessive-compulsive disorder (OCD) from obsessive-compulsive personality disorder (OCPD)? * A. OCD is ego-syntonic, OCPD is ego-dystonic * B. OCPD includes distressing rituals and compulsions * C. OCD involves intrusive thoughts and rituals; OCPD reflects rigid traits without distress * D. There is no meaningful distinction

Answer 65

C. OCD involves intrusive thoughts and rituals; OCPD reflects rigid traits without distress ## Footnote OCD is ego-dystonic and marked by unwanted obsessions, while OCPD reflects rigid personality patterns aligned with the self-image.

Question 66

A 34-year-old woman experienced a sexual assault 5 weeks ago. Since then, she has had recurrent distressing dreams of the assault, avoids leaving her home, and startles easily. She has difficulty sleeping and feels emotionally numb. **Which diagnosis is most appropriate?** * A. Acute Stress Disorder * B. Posttraumatic Stress Disorder * C. Adjustment Disorder with Anxiety * D. Persistent Depressive Disorder

Answer 66

B. Posttraumatic Stress Disorder

Question 67

While discussing Erikson’s identity crisis in a multicultural counseling class, a student asks whether Piaget’s stages are universal. **The instructor responds by citing research that children sometimes perform better on perspective-taking tasks when the tasks involve familiar materials and contexts. What Piagetian concept or finding is most relevant here?** * A. Assimilation is culturally biased * B. Egocentrism can be overcome earlier when tasks are designed appropriately * C. Conservation only develops in Western cultures * D. Horizontal décalage does not exist

Answer 67

B. Egocentrism can be overcome earlier when tasks are designed appropriately ## Footnote Later studies showed that children demonstrate perspective-taking skills earlier when tasks are simplified or involve familiar, meaningful contexts. This challenges Piaget’s claim that egocentrism persists universally until about age seven.

Question 68

A client reports she “can’t fully commit” in a relationship until she knows her purpose in life. According to Erikson, she must **first resolve:** * A. Intimacy vs. Isolation * B. Identity vs. Role Confusion * C. Generativity vs. Stagnation * D. Industry vs. Inferiority

Answer 68

B. Identity vs. Role Confusion ## Footnote Unresolved identity issues in adolescence can delay entry into the intimacy vs. isolation stage of early adulthood. A stable sense of self is foundational to forming healthy, lasting intimate relationships.

Question 69

A counselor observes that her pre-K client can sort toys by color but not by both color and shape. **According to Piaget, which concept has not yet fully developed, and in which stage does it typically emerge?** * A. Seriation; sensorimotor * B. Classification by multiple attributes; concrete operational * C. Centration; formal operational * D. Abstract thought; preoperational

Answer 69

B. Classification by multiple attributes; concrete operational ## Footnote During the concrete operational stage (ages 7–11), children gain the ability to classify objects by multiple attributes and to arrange items in order (seriation). Younger children often focus on a single characteristic (centration).

Question 70

Which statement **BEST captures the difference between avoidant personality disorder and social anxiety disorder?** * A. Avoidant clients lack awareness of their behaviors. * B. Social anxiety is ego-syntonic, while avoidant traits are ego-dystonic. * C. Avoidant personality involves a broader pattern of inhibition across relationships. * D. Social anxiety disorder is not related to interpersonal fears.

Answer 70

C. Avoidant personality involves a broader pattern of inhibition across relationships. ## Footnote Avoidant PD includes pervasive inhibition and sensitivity to criticism in most settings, while social anxiety may be more situational.

Question 71

A 27-year-old woman has recurrent episodes of eating nonfood substances such as chalk and paper for over a year. **What is the diagnosis?** * A. Rumination Disorder * B. Pica * C. Avoidant/Restrictive Food Intake Disorder * D. Anorexia Nervosa

Answer 71

B. Pica

Question 72

All of the following are characteristics of an authoritative parenting style **EXCEPT**: * A. High warmth and high control * B. Clear limits and expectations * C. Strict enforcement without explanation * D. Encouragement of independence

Answer 72

C. Strict enforcement without explanation ## Footnote Strict enforcement without explanation reflects authoritarian parenting, not authoritative parenting, which balances structure with warmth and encourages autonomy.

Question 73

A client begins showing up late to therapy and the therapist no longer engages in friendly small talk at the start of sessions. Eventually, the client returns to punctual behavior. **This is best described as:** * A. Negative punishment * B. Positive punishment * C. Extinction * D. Behavioral rehearsal

Answer 73

A. Negative punishment ## Footnote A pleasant stimulus (social chat) was removed to decrease the undesirable behavior (lateness).

Question 74

A 47-year-old man describes a persistent pattern of disregard for and violation of others’ rights since his teens. He has multiple arrests for theft and assault, lies for personal gain, and shows no remorse. **Which diagnosis is most consistent?** * A. Narcissistic Personality Disorder * B. Antisocial Personality Disorder * C. Borderline Personality Disorder * D. Conduct Disorder, Adolescent-Onset Type

Answer 74

B. Antisocial Personality Disorder

Question 75

Which factor is **MOST important to assess when treating a client with a personality disorder?** * A. Level of intelligence * B. Degree of insight and motivation for change * C. Presence of hallucinations * D. Preferred learning style

Answer 75

B. Degree of insight and motivation for change ## Footnote Personality disorders are ego-syntonic; assessing readiness for change and insight is crucial for treatment planning.

Question 76

A psychologist observes that adults continue to integrate new experiences into existing belief systems, sometimes rejecting information that does not fit. **When a deeply held schema must change, the person experiences discomfort and actively reorganizes their worldview. Piaget would describe this lifelong process as:** * A. Centration and egocentrism * B. Assimilation and accommodation restoring cognitive equilibrium * C. Object permanence and conservation * D. Horizontal décalage

Answer 76

B. Assimilation and accommodation restoring cognitive equilibrium ## Footnote For Piaget, learning involves assimilation (fitting experiences into existing schemas) and accommodation (changing schemas when necessary). This interplay reduces cognitive disequilibrium and continues throughout life.

Question 77

A therapist working with a child who has developed a fear of dogs discovers the fear began after the child was bitten by a large German shepherd. Now, even small friendly dogs provoke anxiety. **This is an example of:** * A. Operant conditioning * B. Stimulus discrimination * C. Stimulus generalization * D. Counterconditioning

Answer 77

C. Stimulus generalization ## Footnote The child’s fear has generalized from one dog to other similar stimuli (other dogs).

Question 78

A therapist notices that a veteran becomes anxious whenever he hears fireworks. He reports that the sound reminds him of gunfire from his time in combat. In classical conditioning terms, **the fireworks are best described as:** * A. Unconditioned stimulus * B. Conditioned stimulus * C. Neutral stimulus * D. Reinforcement

Answer 78

B. Conditioned stimulus ## Footnote The fireworks, originally neutral, became associated with trauma (gunfire), thus now trigger anxiety as a conditioned stimulus.

Question 79

Cognitive dissonance theory is most closely aligned with **which theoretical orientation in counseling?** * A. Humanistic * B. Behavioral * C. Cognitive * D. Psychoanalytic

Answer 79

C. Cognitive ## Footnote Cognitive dissonance theory centers on internal thought processes and the tension between beliefs and behaviors, placing it within the cognitive framework.

Question 80

A 26-year-old man is preoccupied with orderliness, perfectionism, and control at the expense of flexibility, efficiency, and openness. This causes interpersonal conflict but he views his behavior as appropriate. **What is the diagnosis?** * A. Obsessive-Compulsive Disorder * B. Narcissistic Personality Disorder * C. Obsessive-Compulsive Personality Disorder * D. Paranoid Personality Disorder

Answer 80

C. Obsessive-Compulsive Personality Disorder

Question 81

A 15-year-old girl reports restrictive eating for 6 months, intense fear of gaining weight, and perceives herself as “fat” despite a BMI of 15. **Which diagnosis is most consistent?** * A. Anorexia Nervosa, Restricting Type * B. Bulimia Nervosa * C. Avoidant/Restrictive Food Intake Disorder * D. Body Dysmorphic Disorder

Answer 81

A. Anorexia Nervosa, Restricting Type

Question 82

A 48-year-old woman reports an intense need to be taken care of, fears separation, and is unwilling to make everyday decisions without reassurance from others. **What is the diagnosis?** * A. Dependent Personality Disorder * B. Avoidant Personality Disorder * C. Borderline Personality Disorder * D. Histrionic Personality Disorder

Answer 82

A. Dependent Personality Disorder

Question 83

A client avoids a specific road after being in a car accident there months ago. Now, the road alone triggers anxiety. **What best explains this behavior?** * A. Classical conditioning * B. Operant reinforcement * C. Displacement * D. Spontaneous recovery

Answer 83

A. Classical conditioning ## Footnote The anxiety is a conditioned response to a previously neutral stimulus (the road).

Question 84

In therapy, a seven-year-old patient can take another child’s perspective in a role-play about sharing but still struggles to imagine how a hypothetical character might feel in a story set in another country. **How does Piaget’s concept of decentration help explain this pattern?** * A. Decentration is complete by age five * B. Decentration allows considering multiple aspects but remains tied to concrete situations * C. Decentration and conservation develop independently * D. Decentration is synonymous with egocentrism

Answer 84

B. Decentration allows considering multiple aspects but remains tied to concrete situations ## Footnote Decentration permits children to consider multiple perspectives and aspects, aiding conservation, classification, and social thinking. However, it is initially limited to concrete, familiar contexts; abstract decentration emerges later.

Question 85

In a session, a client reports feeling uneasy whenever she hears the ringtone she used to have when her ex-partner would call during arguments. **The ringtone is acting as a:** * A. Reinforcer * B. Conditioned stimulus * C. Punisher * D. Unconditioned response

Answer 85

B. Conditioned stimulus ## Footnote The ringtone is now associated with distressing memories and functions as a conditioned stimulus.

Question 86

A counselor treats a client’s phobia of elevators using exposure therapy and breathing exercises. After repeated sessions, the client begins to feel calm upon entering an elevator. **This is an example of:** * A. Stimulus generalization * B. Classical conditioning * C. Fixed-ratio reinforcement * D. Modeling

Answer 86

B. Classical conditioning ## Footnote The formerly anxiety-inducing stimulus (elevator) is now associated with calmness through conditioning.

Question 87

A 22-year-old college senior reports periods lasting several days where she feels “on top of the world,” sleeps only 3 hours a night without fatigue, talks rapidly, and takes on multiple projects she cannot finish. She says these episodes alternate with weeks where she feels “empty” and avoids friends. Her friends say her grades fluctuate drastically. These patterns have been occurring for the past 2 years. **Which DSM-5 diagnosis is most accurate?** * A. Bipolar I Disorder * B. Bipolar II Disorder * C. Cyclothymic Disorder * D. Persistent Depressive Disorder

Answer 87

B. Bipolar II Disorder

Question 88

A researcher notices that a rural child who helps measure and mix ingredients for family meals learns to conserve quantity and classify objects earlier than the urban children in Piaget’s original studies. **What critique of Piaget’s theory does this observation support?** * A. Piaget overlooked emotional development * B. Cognitive development depends on experience and culture, not just maturation * C. The formal operational stage occurs at age two * D. Children universally master centration before conservation

Answer 88

B. Cognitive development depends on experience and culture, not just maturation ## Footnote Cross-cultural research shows that children who engage in complex tasks often develop logical reasoning skills earlier. This suggests that Piaget underestimated the role of experience and culture.

Question 89

A client with antisocial traits repeatedly lies to avoid consequences. **What is the MOST appropriate counselor action?** * A. Offer empathy and reflect the client's frustration * B. Ignore the behavior to avoid confrontation * C. Address the behavior directly and maintain clear expectations * D. Terminate the counseling relationship

Answer 89

C. Address the behavior directly and maintain clear expectations ## Footnote Addressing manipulative behavior directly and consistently reinforces boundaries and ethical expectations.

Question 90

A 15-year-old girl intentionally produces symptoms of hypoglycemia by injecting insulin she does not need. She denies external incentives. **What is the diagnosis?** * A. Malingering * B. Factitious Disorder Imposed on Self * C. Somatic Symptom Disorder * D. Conversion Disorder

Answer 90

B. Factitious Disorder Imposed on Self

Question 91

A counselor notes that her adolescent client can think logically about mathematical equations but struggles to imagine hypothetical moral scenarios. **According to Piaget, what might this tell us about abstract thinking?** * A. Abstract reasoning develops uniformly across domains * B. There may be domain-specific variations; some forms of abstraction (e.g., mathematical) emerge before others (e.g., ethical) * C. The client is regressing to the sensorimotor stage * D. Abstract thinking does not depend on prior experience

Answer 91

B. There may be domain-specific variations; some forms of abstraction (e.g., mathematical) emerge before others (e.g., ethical) ## Footnote Piaget acknowledged that formal operational thinking may develop unevenly across domains; adolescents might show abstract reasoning in one area but not another. Experience and context influence the emergence of abstract thought.

Question 92

A 42-year-old woman presents with progressive memory loss, language difficulties, and impaired executive function over the past 2 years. She remains alert and oriented to time and place. **Which diagnosis is most consistent?** * A. Major Neurocognitive Disorder due to Alzheimer’s Disease * B. Delirium * C. Mild Neurocognitive Disorder * D. Schizophrenia

Answer 92

A. Major Neurocognitive Disorder due to Alzheimer’s Disease

Question 93

A client with antisocial personality disorder expresses no guilt about harming others. **Which term BEST describes this characteristic?** * A. Ego-dystonic behavior * B. Externalizing defense * C. Ego-syntonic worldview * D. Moral injury

Answer 93

C. Ego-syntonic worldview ## Footnote The client’s lack of remorse reflects ego-syntonic thinking, where behaviors align with their self-perception and values.

Question 94

A 30-year-old man is suspicious of others, interprets benign remarks as threats, and bears grudges, but has no fixed delusions or hallucinations. **What is the diagnosis?** * A. Schizotypal Personality Disorder * B. Paranoid Personality Disorder * C. Schizophrenia * D. Delusional Disorder

Answer 94

B. Paranoid Personality Disorder

Question 95

Failure to resolve identity formation in adolescence **MOST directly impacts**: * A. Trust development in infancy * B. Autonomy in early childhood * C. Capacity for long-term intimate relationships * D. Ability to resolve midlife stagnation

Answer 95

C. Capacity for long-term intimate relationships ## Footnote Without a clear identity, individuals struggle with the intimacy vs. isolation stage, leading to avoidance or instability in close relationships.

Question 96

A 40-year-old man has periods of intense irritability and inflated self-esteem lasting 5 days, with increased goal-directed activity and risky spending. He also has episodes of depressed mood for 2 weeks. **Which diagnosis is most consistent?** * A. Bipolar I Disorder * B. Bipolar II Disorder * C. Cyclothymic Disorder * D. Persistent Depressive Disorder

Answer 96

A. Bipolar I Disorder

Question 97

A client with dependent personality disorder avoids decision-making and defers all choices to the counselor. **What should the counselor do FIRST?** * A. Continue making decisions to avoid client anxiety * B. Set limits and refer for psychiatric evaluation * C. Support gradual autonomy through collaborative decision-making * D. Explore childhood trauma and attachment history

Answer 97

C. Support gradual autonomy through collaborative decision-making ## Footnote Dependent clients benefit from guided autonomy. A collaborative approach builds confidence without triggering fear of abandonment.

Question 98

Why is cognitive dissonance particularly useful in **motivational interviewing and behavior change counseling?** * A. It allows the counselor to impose healthier beliefs * B. It leverages internal conflict to promote self-driven change * C. It encourages clients to avoid uncomfortable truths * D. It justifies external pressure on clients

Answer 98

B. It leverages internal conflict to promote self-driven change ## Footnote Motivational interviewing uses dissonance gently, allowing clients to notice discrepancies and choose change based on their own values.

Question 99

Scenario: A toddler in daycare begins crying whenever the parent leaves, but quickly calms and engages in play. The parent reports this behavior started shortly after the child began exploring independently at home. Which of the following is **NOT** consistent with Mahler’s theory of development? * A. The child is likely in the practicing subphase of separation–individuation * B. Separation anxiety can be part of normal emotional development * C. The behavior is entirely inconsistent with secure attachment * D. Increased exploration signals growing autonomy

Answer 99

C. The behavior is entirely inconsistent with secure attachment ## Footnote Securely attached children may still show distress at separation while maintaining trust in the caregiver’s return.

Question 100

A client with **avoidant personality disorder may reject praise because**: * A. They are suspicious of the counselor's motives * B. They believe they do not deserve positive feedback * C. They want to challenge the counselor * D. They have narcissistic traits

Answer 100

B. They believe they do not deserve positive feedback ## Footnote Avoidant clients struggle with feelings of inadequacy and fear rejection, making it difficult to accept positive regard.

Question 101

A client with paranoid personality disorder is **MOST likely to respond to feedback by:** * A. Thanking the counselor for their honesty * B. Believing the counselor has a hidden agenda * C. Denying all mistakes and blaming others * D. Displaying flat affect and indifference

Answer 101

B. Believing the counselor has a hidden agenda ## Footnote Paranoid clients are hypervigilant and suspicious, often interpreting neutral actions as threatening or manipulative.

Question 102

A 28-year-old woman reports feeling detached from her own body and surroundings, as if she is observing herself from outside. Episodes last minutes to hours and cause distress. **Which diagnosis is most consistent?** * A. Dissociative Identity Disorder * B. Depersonalization/Derealization Disorder * C. Schizophrenia * D. Panic Disorder

Answer 102

B. Depersonalization/Derealization Disorder

Question 103

Which intervention is **MOST effective for clients with antisocial personality disorder in a residential treatment setting?** * A. Exploratory therapy focusing on past trauma. * B. Group therapy emphasizing emotional expression. * C. Behavioral contracts and consistent rule enforcement. * D. Encouraging self-reflection and journaling.

Answer 103

C. Behavioral contracts and consistent rule enforcement. ## Footnote Behavioral management and external consequences are effective, as these clients often lack internalized values or empathy.

Question 104

A counselor working with a child who has developed a fear of school after being bullied may use systematic desensitization to help reduce anxiety. **This approach is rooted in which behavioral principle**? * A. Negative punishment * B. Shaping * C. Classical conditioning * D. Operant conditioning

Answer 104

C. Classical conditioning ## Footnote Systematic desensitization is based on classical conditioning, where a neutral stimulus (school) is gradually associated with relaxation rather than anxiety.

Question 105

A 14-year-old girl refuses to go to school for the last 3 months, saying she is terrified of being embarrassed while giving presentations. She reports sweating, shaking, and nausea when thinking about speaking in front of her peers. **Which diagnosis is most consistent?** * A. Social Anxiety Disorder * B. Specific Phobia, Situational Type * C. Generalized Anxiety Disorder * D. Panic Disorder

Answer 105

A. Social Anxiety Disorder

Question 106

During parent training, the counselor explains that ignoring tantrums (withholding attention) can help reduce them over time. **This behavioral strategy relies on:** * A. Shaping * B. Extinction * C. Negative reinforcement * D. Stimulus discrimination

Answer 106

B. Extinction ## Footnote When a behavior no longer receives reinforcement (e.g., attention), it decreases—this is extinction.

Question 107

A social worker is evaluating the impact of parenting style on a 15-year-old exhibiting risk-taking behavior. The teen describes parents who set strict curfews without explanation, discourage questioning rules, and focus heavily on obedience. All of the following outcomes are more likely under this parenting style **EXCEPT**: * A. Lower self-esteem and poorer social skills * B. Higher levels of conformity in structured settings * C. Strong internal locus of control and high self-regulation * D. Potential for rebellion in unmonitored contexts

Answer 107

C. Strong internal locus of control and high self-regulation ## Footnote Authoritarian parenting (low warmth, high control) often produces obedience but is associated with lower self-esteem, less social competence, and reduced internal locus of control.

Question 108

In therapy, which intervention best facilitates **exploration of cognitive dissonance?** * A. Guided imagery to reduce stress * B. Validating client defenses to build rapport * C. Socratic questioning targeting belief-behavior gaps * D. Assigning a symptom checklist

Answer 108

C. Socratic questioning targeting belief-behavior gaps ## Footnote Socratic questioning helps clients uncover inconsistencies between beliefs and actions—central to addressing cognitive dissonance.

Question 109

A therapist uses a relaxation script while a client imagines the feared situation of public speaking. Over time, the client's anxiety decreases. **This process is best described as:** * A. Classical conditioning through reinforcement * B. Shaping of behavior * C. Counterconditioning * D. Negative reinforcement

Answer 109

C. Counterconditioning ## Footnote Counterconditioning replaces the anxiety response with relaxation when paired with the feared stimulus.

Question 110

A child learns to associate the sound of the pantry door opening with receiving a treat. Eventually, the sound alone causes excitement. In classical conditioning, **the sound of the door is:** * A. Unconditioned stimulus * B. Conditioned stimulus * C. Neutral response * D. Reinforcer

Answer 110

B. Conditioned stimulus ## Footnote The previously neutral sound becomes a conditioned stimulus once it's paired with the unconditioned stimulus (treat).

Question 111

A 33-year-old man is brought to the ER after telling coworkers the FBI has bugged his office. Symptoms began suddenly 5 days ago following job loss. No mood symptoms are present. **Which diagnosis is most consistent?** * A. Brief Psychotic Disorder * B. Schizophreniform Disorder * C. Schizophrenia * D. Delusional Disorder

Answer 111

A. Brief Psychotic Disorder

Question 112

A therapist works with an 11-year-old who enjoys solving complex puzzles and begins questioning traditional rules. She debates whether justice is served by obeying unjust laws and imagines societies structured differently from her own. **According to Piaget, what stage is she entering, and what capacity does this reflect?** * A. Concrete operational; centration * B. Formal operational; abstract and hypothetical reasoning * C. Sensorimotor; symbolic play * D. Preoperational; animism

Answer 112

B. Formal operational; abstract and hypothetical reasoning ## Footnote The formal operational stage involves the ability to think abstractly, reason hypothetically, and consider possibilities beyond direct experience. The adolescent’s questioning of laws reflects this new capacity.

Question 113

A client with Borderline Personality Disorder repeatedly self-injures and threatens suicide when appointments are rescheduled. **What is the counselor’s BEST initial response?** * A. Refer the client for crisis stabilization. * B. Enforce clear boundaries while validating the client's distress. * C. Allow schedule changes to be flexible for this client. * D. Focus sessions solely on safety planning.

Answer 113

B. Enforce clear boundaries while validating the client's distress. ## Footnote Clients with BPD benefit from a balance of empathy and boundary-setting to reduce manipulation while supporting emotional regulation.

Question 114

A 27-year-old says, “I don’t have a ‘self,’ I’m just whoever people want me to be.” Which technique would **BEST support stage resolution?** * A. Role-play scenarios to practice asserting preferences * B. Avoid role-plays to prevent discomfort * C. Focus on past childhood punishments only * D. Provide vocational testing results without discussion

Answer 114

A. Role-play scenarios to practice asserting preferences ## Footnote Role-playing can help the client practice self-assertion and develop a clearer sense of identity.

Question 115

During therapy, a counselor helps a client stop nail biting by applying a bitter-tasting solution to the nails. The client reduces the behavior to avoid the unpleasant taste. **This method uses:** * A. Positive reinforcement * B. Classical conditioning * C. Positive punishment * D. Negative reinforcement

Answer 115

C. Positive punishment ## Footnote The addition of an aversive stimulus (bitter taste) to reduce a behavior is positive punishment.

Question 116

A 45-year-old man reports hearing voices commenting on his behavior for the past 2 months. He has become socially withdrawn and his work performance has declined. He denies substance use, mood symptoms, or medical illness. There is no known history of similar episodes. **What is the most likely diagnosis?** * A. Schizophrenia * B. Schizophreniform Disorder * C. Brief Psychotic Disorder * D. Schizoaffective Disorder

Answer 116

B. Schizophreniform Disorder

Question 117

A 22-year-old man reports recurrent episodes where his heart races, he sweats, and he feels short of breath after being bitten by a dog as a child. These episodes occur whenever he sees a dog. **Which diagnosis is most consistent?** * A. Specific Phobia, Animal Type * B. Panic Disorder * C. PTSD * D. Social Anxiety Disorder

Answer 117

A. Specific Phobia, Animal Type

Question 118

A man flinches whenever his partner opens the silverware drawer because it used to be followed by her yelling during fights. Now, the sound of the drawer alone causes a fear response. **What role does the silverware drawer play?** * A. Unconditioned stimulus * B. Neutral stimulus * C. Conditioned stimulus * D. Secondary reinforcer

Answer 118

C. Conditioned stimulus ## Footnote The sound of the drawer became associated with yelling, turning it into a conditioned stimulus.

Question 119

A 6-year-old boy has repetitive behaviors, restricted interests in train schedules, and difficulty with social reciprocity. He meets developmental milestones in motor skills. **What is the diagnosis?** * A. Autism Spectrum Disorder * B. ADHD, Combined Type * C. Intellectual Disability * D. Social Anxiety Disorder

Answer 119

A. Autism Spectrum Disorder

Question 120

A teacher observes that her 8-year-old students can explain that eight ounces of water remain eight ounces regardless of the shape of the glass, and they grasp that a scrambled egg is still an egg. According to Piaget, **which cognitive stage are these children in, and what kind of learning activities are most appropriate?** * A. Preoperational; imaginative and symbolic play * B. Concrete operational; hands-on tasks that involve logical reasoning about the physical world * C. Formal operational; debates about hypothetical moral dilemmas * D. Postformal; complex abstract reasoning beyond Piaget’s theory

Answer 120

B. Concrete operational; hands-on tasks that involve logical reasoning about the physical world ## Footnote Children aged 7–11 are in the concrete operational stage, during which they develop the ability to think logically about the physical world and understand conservation. Hands-on activities that allow them to manipulate concrete materials support this stage.

Question 121

A 26-year-old graduate student reports frequent worry about a variety of topics, including her grades, finances, and her parents’ health. She describes feeling restless, fatigued, and having difficulty concentrating for the past 9 months. She denies panic attacks, obsessions, or compulsions. Her physical exam is normal. **Which diagnosis is most consistent with her presentation?** * A. Adjustment Disorder with Anxiety * B. Generalized Anxiety Disorder * C. Persistent Depressive Disorder * D. Somatic Symptom Disorder

Answer 121

B. Generalized Anxiety Disorder

Question 122

A 29-year-old woman presents with episodes of sudden intense fear that peak within minutes. During these episodes she experiences palpitations, sweating, trembling, and fear of dying. She worries daily about when the next episode will occur and avoids places where she has panicked before. **Which diagnosis is most consistent with DSM-5 criteria?** * A. Panic Disorder * B. Agoraphobia * C. Social Anxiety Disorder * D. Generalized Anxiety Disorder

Answer 122

A. Panic Disorder

Question 123

A school counselor notices that a student becomes visibly tense when hearing the school bell, which used to ring before daily detention. **Which phase of classical conditioning is the bell in?** * A. Before conditioning (neutral stimulus) * B. During acquisition (paired with punishment) * C. After conditioning (conditioned stimulus) * D. During extinction (no longer paired)

Answer 123

C. After conditioning (conditioned stimulus) ## Footnote The bell, now associated with a negative experience, elicits a fear response as a conditioned stimulus.

Question 124

In operant conditioning, **extinction occurs when:** * A. A behavior increases because it is consistently reinforced. * B. A previously reinforced behavior no longer receives reinforcement and decreases. * C. A conditioned stimulus is paired with a new unconditioned stimulus. * D. A stimulus similar to the conditioned stimulus elicits the same response.

Answer 124

B. A previously reinforced behavior no longer receives reinforcement and decreases. ## Footnote Extinction in operant conditioning means the behavior weakens when reinforcement stops.

Question 125

While exploring identity, a client shares she is considering a same-sex relationship but fears community rejection. The counselor’s **BEST ethical responsibility is to**: * A. Encourage concealment for safety without further discussion * B. Create a safe space for exploring identity while addressing risks and supports * C. Avoid discussing relationships * D. Suggest avoiding dating until identity is “finalized”

Answer 125

B. Create a safe space for exploring identity while addressing risks and supports ## Footnote Counselors have an ethical duty to provide a safe, affirming space while addressing potential risks and identifying supports for the client’s decision-making.

Question 126

A child persists in labeling all round objects “ball” despite being corrected, then eventually adjusts and distinguishes between apples and balls. **According to Piaget, what two complementary processes are illustrated here?** * A. Scaffolding and the zone of proximal development * B. Assimilation followed by accommodation * C. Conservation and centration * D. Abstract thinking and seriation

Answer 126

B. Assimilation followed by accommodation ## Footnote When new experiences fit existing schemas (calling an apple a “ball”), a child is assimilating. When the child modifies the schema to differentiate apples from balls, they are accommodating. Together these processes restore equilibrium.

Question 127

A 15-year-old boy is brought in by his parents after being suspended for fighting at school. They report he has been bullying peers, lying to get out of trouble, and stealing from classmates for over a year. He has no signs of remorse and blames others for his actions. **Which DSM-5 diagnosis best fits?** * A. Oppositional Defiant Disorder * B. Antisocial Personality Disorder * C. Conduct Disorder, Childhood-Onset Type * D. Intermittent Explosive Disorder

Answer 127

C. Conduct Disorder, Childhood-Onset Type

Question 128

A counselor is designing a psychoeducational workshop comparing Freud and Erikson. **Which of the following statements would be MOST accurate?** * A. Freud emphasized sexual drives, while Erikson focused on social and cultural influences. * B. Freud proposed eight stages of development, while Erikson proposed five. * C. Freud emphasized the unconscious, while Erikson rejected it entirely. * D. Both Freud and Erikson believed development ended by adolescence.

Answer 128

A. Freud emphasized sexual drives, while Erikson focused on social and cultural influences. ## Footnote Freud’s stages center on psychosexual energy, while Erikson expanded the framework to include social and cultural influences across eight life stages.

Question 129

A 30-year-old man struggles to commit to a relationship, fearing “being tied down.” **Which is the BEST next step?** * A. Explore past relationship patterns to identify recurring avoidance themes * B. Push the client to set a wedding date with his partner * C. Recommend focusing on career instead of relationships * D. Assign daily affirmations without processing deeper fears

Answer 129

A. Explore past relationship patterns to identify recurring avoidance themes ## Footnote Identifying patterns offers insight into how unresolved identity issues affect intimacy.

Question 130

A counselor works with a client from a collectivist culture who feels torn between family expectations and personal career interests. The **BEST culturally responsive approach is to**: * A. Force the client to choose independence over family * B. Explore ways to integrate personal goals with family values * C. Discourage any deviation from family expectations * D. Avoid career discussion entirely

Answer 130

B. Explore ways to integrate personal goals with family values ## Footnote Cultural competence involves helping the client explore ways to integrate rather than abandon cultural values while fostering individual identity.

Question 131

A 33-year-old man repeatedly lies, manipulates others for personal gain, has a history of cruelty to animals, and was arrested multiple times as a teen. He is now 33. **Which diagnosis is most consistent?** * A. Narcissistic Personality Disorder * B. Antisocial Personality Disorder * C. Conduct Disorder * D. Borderline Personality Disorder

Answer 131

B. Antisocial Personality Disorder

Question 132

A 42-year-old man has a history of depressed mood, anhedonia, fatigue, and poor concentration for most of the day, more days than not, over the past 2 years. He has never been symptom-free for more than 2 months. **Which diagnosis is most consistent?** * A. Persistent Depressive Disorder * B. Major Depressive Disorder, Recurrent * C. Cyclothymic Disorder * D. Adjustment Disorder with Depressed Mood

Answer 132

A. Persistent Depressive Disorder

Question 133

A counselor recognizes that a client’s indecisiveness stems partly from systemic oppression that limited educational opportunities. **Which action aligns with ethical practice?** * A. Ignore systemic factors and focus solely on client choices * B. Integrate advocacy and resource connection into identity work * C. Discourage reflection on systemic issues * D. Encourage the client to “move on” from the past

Answer 133

B. Integrate advocacy and resource connection into identity work ## Footnote Ethical counseling requires acknowledging systemic barriers and incorporating advocacy and resource navigation to support identity development.

Question 134

Clients with dependent personality disorder **MOST often exhibit:** * A. Obsession with symmetry and order. * B. A consistent need to be taken care of by others. * C. Avoidance of intimacy due to fear of rejection. * D. Grandiosity and entitlement.

Answer 134

B. A consistent need to be taken care of by others. ## Footnote These clients display clinging, submissive behavior and fear separation, often deferring decisions to others.

Question 135

A client exhibits rigid perfectionism, preoccupation with order, and excessive devotion to work. **Which diagnosis is MOST likely?** * A. Avoidant Personality Disorder * B. Obsessive-Compulsive Personality Disorder * C. Narcissistic Personality Disorder * D. Dependent Personality Disorder

Answer 135

B. Obsessive-Compulsive Personality Disorder ## Footnote Obsessive-Compulsive Personality Disorder is marked by inflexibility, perfectionism, and a need for control. Unlike OCD, it is ego-syntonic.

Question 136

Which approach is **MOST effective when counseling clients with Cluster B personality traits?** * A. Providing total freedom to self-direct * B. Offering frequent reassurance * C. Setting consistent, structured limits * D. Using ambiguous and open-ended rules

Answer 136

C. Setting consistent, structured limits ## Footnote Cluster B clients often test boundaries. Clear structure helps reduce chaos and reinforces expectations.

Question 137

A counselor working with an adolescent struggling with identity formation might **integrate Erikson’s framework by:** * A. Exploring unconscious childhood conflicts rooted in psychosexual stages * B. Supporting the client in experimenting with roles and values in a safe environment * C. Encouraging regression to earlier stages to resolve mistrust issues * D. Analyzing defense mechanisms to reduce anxiety about role confusion

Answer 137

B. Supporting the client in experimenting with roles and values in a safe environment ## Footnote In Erikson’s fifth stage, identity vs. role confusion, adolescents form a sense of self by exploring and integrating roles, beliefs, and values. The counselor’s role would be to provide a supportive space for this exploration.

Question 138

During a diagnostic play session, a four-year-old insists that a pile of coins spread out “has more money” than the same number of coins pushed together. **The counselor suspects the child is operating with one of Piaget’s characteristic limitations. What is this limitation, and how might the counselor support growth?** * A. Egocentrism; by encouraging pretend play * B. Conservation failure due to centration; by having the child manipulate the coins themselves * C. Abstract thought; by discussing moral dilemmas * D. Decentration; by using classification tasks

Answer 138

B. Conservation failure due to centration; by having the child manipulate the coins themselves ## Footnote The child’s focus on the spread of coins shows centration and a lack of conservation. Research suggests children develop conservation earlier when they actively manipulate materials rather than just observe.

Question 139

Which of the following is **NOT** a key concept of Object Relations Theory? * A. Internalization of early caregiver relationships * B. Splitting as a defense mechanism * C. The latency period as a stage of psychosexual development * D. The development of self and others through interpersonal experiences

Answer 139

C. The latency period as a stage of psychosexual development ## Footnote The latency period is from Freud’s psychosexual stages, not Object Relations Theory. Object Relations Theory focuses on how early relationships with caregivers shape internalized representations of self and others.

Question 140

At a family picnic, a five-year-old insists that his brother cannot see the ant on the watermelon because “my eyes are in the way.” **The child is genuinely puzzled when the brother claims to see it from his own side of the table. Which cognitive limitation is most evident here?** * A. Conservation of mass * B. Centration * C. Egocentrism in the preoperational stage * D. Formal operational thought

Answer 140

C. Egocentrism in the preoperational stage ## Footnote Preoperational children struggle to take another person’s perspective; they assume others see what they see. This egocentrism is exemplified in Piaget’s “three mountain task,” where children choose their own view rather than another’s.

Question 141

In an experiment, a dog learns to salivate at the sound of a bell after the bell is repeatedly paired with food. Eventually, the bell rings with no food, and salivation stops. **What has occurred?** * A. Generalization * B. Negative punishment * C. Extinction * D. Habituation

Answer 141

C. Extinction ## Footnote The conditioned response fades when the stimulus (bell) is no longer paired with reinforcement (food).

Question 142

During a therapy session, a counselor notices that a 6-year-old initially calls every four-legged animal “doggie.” After encountering a meowing cat, the child starts to differentiate between dogs and cats. **To help restructure cognitive distortions, which Piagetian processes might the counselor discuss?** * A. Only assimilation * B. Only accommodation * C. A sequence of assimilation followed by accommodation * D. Scaffolding and modeling

Answer 142

C. A sequence of assimilation followed by accommodation ## Footnote The child first assimilates new information into an existing schema (“all furry, four-legged animals are dogs”), then accommodates by adjusting the schema when new information (a cat) doesn’t fit. This interplay helps restore cognitive equilibrium.

Question 143

A 6-year-old boy has difficulty sustaining attention in class, frequently leaves his seat, talks excessively, interrupts others, and has had these symptoms at home and school for the past year. **Which diagnosis is most consistent?** * A. ADHD, Predominantly Inattentive Presentation * B. ADHD, Predominantly Hyperactive/Impulsive Presentation * C. ADHD, Combined Presentation * D. Oppositional Defiant Disorder

Answer 143

C. ADHD, Combined Presentation

Question 144

A 36-year-old woman reports experiencing excessive sleepiness for the past 6 months despite sleeping 8–9 hours per night. She sometimes falls asleep during meetings and while watching TV. She denies cataplexy or hallucinations. **Which diagnosis is most consistent?** * A. Narcolepsy * B. Hypersomnolence Disorder * C. Circadian Rhythm Sleep-Wake Disorder * D. Insomnia Disorder

Answer 144

B. Hypersomnolence Disorder

Question 145

A client diagnosed with dependent personality disorder frequently says, 'I can’t make any decisions without someone helping me.' Which is the **BEST counseling goal?** * A. Help the client accept lifelong reliance on others. * B. Encourage the client to wait for support before acting. * C. Promote confidence in autonomous decision-making. * D. Assign a surrogate decision-maker for the client.

Answer 145

C. Promote confidence in autonomous decision-making. ## Footnote Clients with dependent personality disorder benefit from interventions that build self-confidence and promote independence.

Question 146

A client in her early thirties returns to school for a third degree, explaining she still “hasn’t found the right fit” for her life. She avoids joining student groups and refuses invitations to collaborate on projects. What unresolved psychosocial crisis is **likely at play?** * A. Autonomy vs. Shame and Doubt * B. Industry vs. Inferiority * C. Identity vs. Role Confusion * D. Generativity vs. Stagnation

Answer 146

C. Identity vs. Role Confusion ## Footnote Repeated exploration without commitment reflects identity diffusion, which can block the developmental tasks of intimacy and long-term life direction.

Question 147

Which of the following behaviors is **MOST consistent with narcissistic personality disorder?** * A. Expressing fear of rejection in social settings. * B. Demonstrating shallow, superficial relationships. * C. Exaggerating achievements and demanding admiration. * D. Avoiding emotional intimacy at all costs.

Answer 147

C. Exaggerating achievements and demanding admiration. ## Footnote Narcissistic individuals often display grandiosity, lack of empathy, and a need for constant admiration.

Question 148

A behavior technician reinforces each correct step a client performs while brushing teeth (turning on the water, applying toothpaste, etc.) until the entire routine is mastered. **This method is:** * A. Shaping * B. Token economy * C. Flooding * D. Chaining

Answer 148

D. Chaining ## Footnote Chaining links smaller steps into a complete behavioral sequence.

Question 149

A 32-year-old client describes trying on different lifestyles over the past decade—traveling extensively, changing social circles, and altering her public image—but says she still doesn’t “feel like herself.” She avoids long-term friendships, fearing judgment once “the real me” is revealed. Which crisis **remains unresolved?** * A. Initiative vs. Guilt * B. Industry vs. Inferiority * C. Identity vs. Role Confusion * D. Intimacy vs. Isolation

Answer 149

C. Identity vs. Role Confusion ## Footnote Unclear self-concept and avoidance of close relationships point to an unresolved identity crisis, preventing her from building stable, trusting adult bonds.

Question 150

A 9-year-old girl repeatedly steals items from classmates, lies to avoid punishment, and has destroyed school property over the past year. She shows no remorse. **Which diagnosis is most consistent?** * A. Oppositional Defiant Disorder * B. Conduct Disorder * C. Antisocial Personality Disorder * D. Intermittent Explosive Disorder

Answer 150

B. Conduct Disorder

Question 151

A counselor is working with a client who refuses group therapy, citing a belief that others are 'all fake' and 'out to get me.' **This behavior is MOST characteristic of which disorder?** * A. Schizotypal Personality Disorder * B. Paranoid Personality Disorder * C. Avoidant Personality Disorder * D. Narcissistic Personality Disorder

Answer 151

B. Paranoid Personality Disorder ## Footnote Paranoid PD is marked by pervasive distrust and suspicion of others' motives, often interfering with therapeutic rapport.

Question 152

A supervisor praises an intern only after every 5th successful case review. **This is an example of:** * A. Variable interval schedule * B. Fixed interval schedule * C. Variable ratio schedule * D. Fixed ratio schedule

Answer 152

D. Fixed ratio schedule ## Footnote Reinforcement after a set number of responses (e.g., every 5 cases) is a fixed ratio schedule.

Question 153

A counselor observes that a client alternates between extreme idealization and hatred of the therapist. **What term BEST explains this?** * A. Ego-syntonic resistance * B. Thought broadcasting * C. Splitting * D. Passive aggression

Answer 153

C. Splitting ## Footnote Splitting is a hallmark of borderline personality disorder, resulting in unstable interpersonal dynamics.

Question 154

In therapy, a 32-year-old client says she ends romantic relationships as soon as they start to feel “serious,” fearing she will lose her independence. She reports never feeling certain about her values or life direction. Which Eriksonian crisis is **most likely unresolved?** * A. Trust vs. Mistrust * B. Identity vs. Role Confusion * C. Generativity vs. Stagnation * D. Ego Integrity vs. Despair

Answer 154

B. Identity vs. Role Confusion ## Footnote Without resolving identity formation, individuals may avoid intimacy to protect an unclear sense of self, remaining stuck before the Intimacy vs. Isolation stage.

Question 155

A counselor engages a six-year-old in a water-pouring experiment. When equal amounts of juice are poured from identical glasses into a short, wide cup and a tall, narrow cup, the child exclaims that the tall cup has more. **The counselor then has the child pour the juice back into the original glasses and see that nothing was added or spilled. Which cognitive skill is being practiced, and at what stage does it typically emerge?** * A. Conservation, which develops in the concrete operational stage around age seven * B. Classification, developing in the formal operational stage * C. Egocentrism, typical of the sensorimotor stage * D. Object permanence, emerging in adolescence

Answer 155

A. Conservation, which develops in the concrete operational stage around age seven ## Footnote Understanding that quantity remains the same despite changes in appearance—conservation—emerges around age seven in the concrete operational stage. Younger children believe the amount has changed because they cannot yet mentally reverse the action.

Question 156

Scenario: A 15-year-old describes parents who enforce strict rules without explanation, discourage questioning, and emphasize obedience above all. All of the following outcomes are associated with this parenting style **EXCEPT**: * A. Increased conformity in controlled settings * B. Higher internal locus of control * C. Lower self-esteem * D. Higher potential for rebellion in unsupervised contexts

Answer 156

B. Higher internal locus of control ## Footnote Authoritarian parenting often undermines internal locus of control and autonomy, leading to more external motivation and possible rebellion.

Question 157

A client says, “I’m just going to copy what my parents believe until I figure myself out.” Which counseling focus **BEST addresses her stage of development?** * A. Challenge her beliefs immediately * B. Support differentiation by identifying her own values * C. Encourage total alignment with family values for harmony * D. Avoid discussing values until she is in her 40s

Answer 157

B. Support differentiation by identifying her own values ## Footnote Supporting self-authored values helps resolve identity diffusion.

Question 158

Scenario: A 3-year-old in foster care alternates between clinging to the foster parent and angrily rejecting comfort during transitions. The child experienced multiple disrupted placements and inconsistent caregiving in infancy. Which of the following is **NOT** a likely explanation from Mahler’s Separation–Individuation Theory? * A. The child may be stuck in the rapprochement subphase * B. The child’s ambivalence reflects unresolved early attachment disruptions * C. The child’s behavior is primarily due to unresolved latency-stage conflicts * D. Internalized inconsistent caregiver representations contribute to trust issues

Answer 158

C. The child’s behavior is primarily due to unresolved latency-stage conflicts ## Footnote The latency stage is from Freud’s psychosexual theory (ages 6–12), not Mahler’s model. Mahler’s rapprochement phase explains ambivalence during autonomy development.

Question 159

Clients with schizoid personality disorder are **MOST likely to present with:** * A. Persistent fears of rejection and a desire for relationships. * B. Deep emotional expressions and frequent verbalization. * C. Social detachment and preference for solitary activities. * D. Excessive attention-seeking and dramatic behavior.

Answer 159

C. Social detachment and preference for solitary activities. ## Footnote Schizoid individuals prefer isolation and lack interest in forming close relationships, often appearing emotionally cold.

Question 160

A client tells her counselor that the smell of her father’s cologne makes her feel unsafe, even though he is no longer in her life. **This is likely due to:** * A. Observational learning * B. Negative reinforcement * C. Classical conditioning * D. Positive punishment

Answer 160

C. Classical conditioning ## Footnote The scent (neutral stimulus) became associated with an emotionally charged memory, creating a conditioned response.

Question 161

A client with obsessive-compulsive personality disorder is unlikely to view their behavior as problematic. **This is because the disorder is:** * A. Psychotic in nature * B. Primarily trauma-based * C. Ego-syntonic * D. Medication-resistant

Answer 161

C. Ego-syntonic ## Footnote Individuals with OCPD typically see their perfectionism as helpful and are resistant to changing patterns they perceive as correct.

Question 162

A 19-year-old woman has recurrent episodes where she is unable to recall personal information, usually after arguments. She appears confused but otherwise functions normally. **Which diagnosis is most consistent?** * A. Dissociative Amnesia * B. Dissociative Identity Disorder * C. Depersonalization/Derealization Disorder * D. Schizophrenia

Answer 162

A. Dissociative Amnesia

Question 163

A 35-year-old man reports irritability, difficulty sleeping, poor concentration, and hypervigilance that began 2 weeks after a workplace assault. Symptoms have lasted 3 weeks. **Which diagnosis is most consistent?** * A. Acute Stress Disorder * B. Posttraumatic Stress Disorder * C. Adjustment Disorder with Anxiety * D. Generalized Anxiety Disorder

Answer 163

A. Acute Stress Disorder

Question 164

A teacher gives students a pop quiz every few days with no set schedule. **This is an example of what reinforcement schedule?** * A. Fixed interval * B. Fixed ratio * C. Variable interval * D. Variable ratio

Answer 164

C. Variable interval ## Footnote Unpredictable time-based reinforcement (e.g., quizzes) is a variable interval schedule.

Question 165

Scenario: A 14-year-old describes parents who set clear rules but explain the reasons, encourage input, and balance warmth with expectations. Which of the following is **NOT** typically associated with this parenting style? * A. Higher self-esteem * B. Greater academic success * C. Lower social competence * D. Better emotional regulation

Answer 165

C. Lower social competence ## Footnote Authoritative parenting (high warmth, high control) is linked to strong social skills, not lower social competence.

Question 166

A young adult in therapy identifies 15 potential career paths. The counselor’s **MOST appropriate first step is to:** * A. Narrow the list to two options immediately * B. Provide opportunities to connect career exploration to self-concept * C. Discourage all new career exploration * D. Recommend taking the first job available

Answer 166

B. Provide opportunities to connect career exploration to self-concept ## Footnote Erikson’s theory emphasizes that identity formation involves aligning external choices (career, lifestyle) with internal values and self-concept. Exploring the meaning of each option in relation to the client’s sense of self is the developmentally appropriate first step.

Question 167

A 6-year-old child is showing curiosity about gender differences and imitates the same-sex parent’s behaviors. According to Freud, this **reflects:** * A. The resolution of the Oedipus or Electra complex in the phallic stage * B. The consolidation of trust in the oral stage * C. Social skill acquisition in the latency stage * D. Moral reasoning development in the genital stage

Answer 167

A. The resolution of the Oedipus or Electra complex in the phallic stage ## Footnote In the phallic stage, children resolve unconscious sexual conflicts by identifying with the same-sex parent, which shapes gender role development.

Question 168

Which of the following statements **reflects ego-dystonic thinking?** * A. “I always do everything right. Other people just don’t understand.” * B. “I don’t like how I overreact sometimes—I wish I could change that.” * C. “Everyone should follow my way because it’s the best way.” * D. “It’s not my fault. They’re the ones with the problem.”

Answer 168

B. “I don’t like how I overreact sometimes—I wish I could change that.” ## Footnote Ego-dystonic thoughts feel uncomfortable or inconsistent with a person’s self-perception and often lead to help-seeking behavior.

Question 169

A 37-year-old man believes his coworkers are “out to get him” and that his food is being poisoned at restaurants. He has no hallucinations, formal thought disorder, or mood symptoms, and his daily functioning is mostly intact, though socially he is isolated. This has been ongoing for 3 years. **Most likely DSM-5 diagnosis?** * A. Delusional Disorder, Persecutory Type * B. Paranoid Personality Disorder * C. Schizophrenia * D. Schizotypal Personality Disorder

Answer 169

A. Delusional Disorder, Persecutory Type

Question 170

A counselor notices a client’s identity exploration is triggering symptoms of anxiety. **Ethically, the counselor should**: * A. Halt identity work indefinitely * B. Integrate coping strategies while continuing exploration * C. Push the client to resolve identity quickly despite distress * D. Shift entirely to symptom management without identity focus

Answer 170

B. Integrate coping strategies while continuing exploration ## Footnote Best practice is to integrate symptom management into ongoing developmental work rather than abandon one for the other.

Question 171

A 27-year-old man presents with preoccupation about having ALS despite no neurological findings. He frequently visits multiple doctors for reassurance, but his anxiety persists. **Which diagnosis is most consistent?** * A. Illness Anxiety Disorder * B. Somatic Symptom Disorder * C. Conversion Disorder * D. Generalized Anxiety Disorder

Answer 171

A. Illness Anxiety Disorder

Question 172

A counselor gives a compliment to a group member every time they share openly. **As a result, the client begins speaking more frequently. This reflects:** * A. Positive reinforcement * B. Negative reinforcement * C. Stimulus generalization * D. Negative punishment

Answer 172

A. Positive reinforcement ## Footnote Praise is added to increase the frequency of open sharing.

Question 173

Which of the following **client statements reflects narcissistic traits?** * A. “I’m afraid people will reject me if they get to know me.” * B. “I make better decisions than most therapists I’ve seen.” * C. “I feel empty and don’t know who I am.” * D. “I tend to attach too quickly and fear abandonment.”

Answer 173

B. “I make better decisions than most therapists I’ve seen.” ## Footnote Grandiosity, entitlement, and superiority are core features of narcissistic personality disorder.

Question 174

A counselor is trying to help a young child speak more clearly. She praises the child each time the utterance gets closer to the target word. **This technique is called:** * A. Modeling * B. Counterconditioning * C. Shaping * D. Chaining

Answer 174

C. Shaping ## Footnote Shaping involves reinforcing successive approximations toward a target behavior.

Question 175

A cross-cultural researcher discovers that children who grow up helping with complex agricultural tasks develop logical reasoning skills earlier than Piaget predicted. This suggests that cognitive growth depends not only on biological maturation but also on experience and social interaction. **Which criticism of Piaget’s theory does this finding support?** * A. Piaget’s theory neglects emotional development * B. Piaget underestimated children’s abilities and overemphasized maturation, ignoring cultural and experiential factors * C. Piaget misidentified the names of his stages * D. Piaget focused exclusively on accommodation rather than assimilation

Answer 175

B. Piaget underestimated children’s abilities and overemphasized maturation, ignoring cultural and experiential factors ## Footnote Piaget’s theory overemphasizes maturation and underestimates the role of culture and social interaction. Cross-cultural research shows variation in what children can do at various ages, indicating that environmental support can accelerate cognitive development.

Question 176

A 35-year-old woman has excessive emotionality and attention-seeking behavior beginning by early adulthood. She is uncomfortable when not the center of attention and uses physical appearance to draw focus. **Which diagnosis is most consistent?** * A. Borderline Personality Disorder * B. Histrionic Personality Disorder * C. Narcissistic Personality Disorder * D. Dependent Personality Disorder

Answer 176

B. Histrionic Personality Disorder

Question 177

A 7-year-old in therapy frequently oscillates between seeking closeness with the therapist and expressing intense anger when sessions end. The child has a history of inconsistent caregiving and was recently placed with adoptive parents who use a permissive parenting style. Which of the following is **NOT** consistent with an Object Relations Theory explanation of this presentation? * A. The child’s behavior reflects unresolved rapprochement subphase conflicts * B. The child’s ambivalence may result from internalized inconsistent caregiver representations * C. The child’s anger toward the therapist reflects displacement from early caregiver experiences * D. The child’s emotional instability is best explained by preconventional moral reasoning

Answer 177

D. The child’s emotional instability is best explained by preconventional moral reasoning ## Footnote Preconventional moral reasoning (Kohlberg) is a cognitive–moral stage model, not part of Object Relations Theory, which focuses on internalized early relationships and attachment dynamics.

Question 178

During intake, a client reveals that she constantly seeks perfection in her work, harshly criticizing herself for small mistakes. Which element of psychoanalytic theory **BEST explains this behavior?** * A. An overdeveloped superego formed during the phallic stage * B. An unresolved Oedipus complex during the phallic stage * C. Fixation at the anal stage due to harsh toilet training * D. Weak ego functioning due to unresolved conflicts in the oral stage

Answer 178

A. An overdeveloped superego formed during the phallic stage ## Footnote The superego develops during the phallic stage as children internalize parental and societal rules. An overdeveloped superego can result in excessive guilt and self-criticism, which is consistent with the client’s perfectionism.

Question 179

A counselor implements a behavioral plan where privileges are taken away if a client fails to follow rules. **This consequence represents:** * A. Positive reinforcement * B. Negative punishment * C. Negative reinforcement * D. Response cost

Answer 179

B. Negative punishment ## Footnote Removing a desired stimulus (privileges) to decrease behavior is negative punishment.

Question 180

A 25-year-old man reports recurrent episodes over the past year in which he eats large quantities of food in a short time while feeling a loss of control. He denies purging, fasting, or excessive exercise afterward. His BMI is 33. **Which diagnosis is most consistent?** * A. Binge-Eating Disorder * B. Bulimia Nervosa * C. Night Eating Syndrome * D. Other Specified Feeding or Eating Disorder

Answer 180

A. Binge-Eating Disorder

Question 181

A client with social anxiety gradually begins attending group sessions. The therapist uses positive reinforcement after each milestone: entering the room, sitting down, and sharing once. **This is an example of:** * A. Extinction * B. Flooding * C. Shaping * D. Exposure

Answer 181

C. Shaping ## Footnote Shaping reinforces each step toward the goal behavior—in this case, full participation.

Question 182

A client with a history of substance use learns that each time they engage in a coping skill (like journaling), they feel less anxiety. **This decrease in anxiety reinforces the behavior. What process is at work?** * A. Negative reinforcement * B. Positive punishment * C. Extinction * D. Habituation

Answer 182

A. Negative reinforcement ## Footnote Removal of an aversive stimulus (anxiety) strengthens the behavior—negative reinforcement.

Question 183

A 29-year-old woman presents with severe mood swings, chronic feelings of emptiness, unstable relationships, and impulsive spending and sexual behavior. She has a history of self-injury. **Which diagnosis is most consistent?** * A. Borderline Personality Disorder * B. Histrionic Personality Disorder * C. Bipolar II Disorder * D. Antisocial Personality Disorder

Answer 183

A. Borderline Personality Disorder

Question 184

A therapist uses dissonance deliberately by asking a client, “If you say you value independence, why do you rely on your partner for all decisions?” **What is the likely goal of this approach?** * A. Instill guilt to prompt change * B. Create discomfort to foster internal realignment * C. Test the therapeutic alliance * D. Reduce dependency through confrontation

Answer 184

B. Create discomfort to foster internal realignment ## Footnote Therapists may intentionally highlight contradictions to activate dissonance, increasing motivation for behavior or belief change.

Question 185

A client tells the counselor, “I’m only here because my spouse made me come.” **Which personality feature does this MOST likely represent?** * A. External locus of control * B. Ego-dystonic awareness * C. Narcissistic entitlement * D. Magical thinking

Answer 185

A. External locus of control ## Footnote Blaming external forces rather than acknowledging internal issues is typical of an external locus of control, often seen in Cluster B disorders.

Question 186

A client tells the counselor, 'No one understands how special I am.' This **MOST likely reflects:** * A. Narcissistic Personality Disorder * B. Avoidant Personality Disorder * C. Borderline Personality Disorder * D. Dependent Personality Disorder

Answer 186

A. Narcissistic Personality Disorder ## Footnote Narcissistic individuals often feel superior and misunderstood by others, seeking admiration and validation.

Question 187

A client says, “I used to think gambling was wrong, but after going a few times with friends, I see it differently.” **What dissonance strategy is reflected?** * A. Denial * B. Identity diffusion * C. Belief adjustment * D. Displacement

Answer 187

C. Belief adjustment ## Footnote The client changed their belief to match behavior, a core mechanism for reducing dissonance when values and actions are misaligned.

Question 188

A counselor assigns consistent consequences for rule-breaking in a residential facility. **This strategy is MOST appropriate for:** * A. Borderline personality disorder * B. Dependent personality disorder * C. Antisocial personality disorder * D. Avoidant personality disorder

Answer 188

C. Antisocial personality disorder ## Footnote Structured consequences help manage manipulation and impulsivity in antisocial clients, who often disregard rules unless externally enforced.