Throughout your career as a Marriage and Family Therapist, there will be times when you are required to work with clients who are experiencing crises. In these situations, you will need to know how to manage their safety (and the public’s safety) by determining exactly which crisis interventions are most appropriate. The Board of Behavioral Services (BBS), whose mission is to, “Protect and serve Californians by setting, communicating, and enforcing standards for safe and competent mental health practice,” will test your knowledge of and ability to utilize crisis interventions. Let’s take a look at how this topic could be tested:
The test may ask:
- Assess a client’s risk to self or others
- Identify and provide referrals
- Identify legal mandates
- Engage support systems
There are many ways this topic could appear on your exam, so it is important to know how to navigate different types of crises and identify crisis interventions that align with the level of risk.
Let’s test your knowledge of crisis interventions with the following FREE MFT exam question:
A therapist working in private practice has been working with a 15-year-old girl with a history of non-suicidal cutting. The parents consented to their daughter’s treatment and have, on occasion, attended conjoint therapy sessions. The client appears for an individual session with tears streaming down her face. She tells the therapist that she had sent a nude picture of herself to her ex-boyfriend several months ago and now it is being circulated at school. She tells the therapist that she is so embarrassed and doesn’t know how she can face anyone ever again. The girl tells the therapist that she doesn't want her parents to know about this. Which of the following interventions should the therapist take to manage the situation presented in this case?
A. Inform client that her parents must be notified
Make a child abuse report to the appropriate authorities
Assess client for potential risk to self
B. Inform client that her parents must be notified
Assess for child abuse and determine need to report
Process child abuse report with client
C. Explore client’s fears regarding parents learning of situation
Make a child abuse report and process with client
Safety plan with client and identify healthy coping skills
D. Explore client’s fears regarding parents learning of situation
Make a child abuse report and process with client
Assess client for potential risk of self-harm
(scroll down for answer and rationale…..)
The correct answer is D.
This vignette is tricky because several issues require immediate attention. We see the issues of confidentiality of a minor, child pornography and mandated reporting requirements, and risk of self-harm. We want to find an answer that addresses all of the issues presented and interventions that align with the level of risk indicated in the vignette.
Answer A and B, based on the information we have so far, can be eliminated because we are not required to inform the client’s parents about the situation. Even if the parents consented to treatment, minors who are old enough to consent to their own treatment, have a right to confidentiality. Answer B is also wrong because we do not need to assess for child abuse; distribution of child pornography, even if initially shared by the minor, is a mandated report.
This leaves us choosing between answers C and D. As you can see, the first two parts of each answer are identical. We would absolutely want to understand why the client is scared of informing her parents, because this information would allow the therapist to determine how to proceed. This could lead to engaging in role play with the client to prepare her to tell parents, or possibly to conducting a conjoint session. We would also want to discuss the need for a child abuse report, and what this will mean for the client.
The final part of answers C and D are quite different. Answer D, “ Assess client for potential risk of self-harm” would be the best crisis intervention to start. Safety planning will be appropriate if the assessment indicates a risk. However, safety planning prior to assessment would not make sense.
To learn all about crisis intervention and more, sign up for one of TDC’s MFT exam study guides to help you prepare for your exam today! Amanda Rowan has helped thousands of Marriage and Family Therapists pass their MFT exams-are you our next success story?
Whenever I read these on LinkedIn I can always hear your voice Amanda reading the question to me. And I really like that you post these it helps me a lot as I’m getting ready to take my test.
That is wonderful to hear, Terri. Keep up the good work :)
Hi Sara, Yes, you are correct. Consent and confidentiality are two separate issues with minors and it's important to keep them that way. If a client is old enough to consent to their own treatment, they have a right to confidentiality.
Hope that helps!
Thanks for the extension of access to exam preparation program. I was just about to request an extension when i noticed the change. My exam has been pushed back to September 2020. I am hoping a plan is in place to navigate COVID by then. I am working real hard to stay focused and not allow the anxiety to become overwhelming, even though I am a high risk person and very worried about the testing environment on test day. Thanks also for the update on Teletherapy was very helpful in clarifying key points of practice. Best wishes to all my fellow test takers. Lilly Rosado
Hi Robin, Can you please further clarify as follow up to Sara's well-written question and your comment?:
1. The question stem states the PARENTS consented to treatment and does NOT state that the 15 year old client consented to treatment. In your explanation of answer you write, "Even if the parents consented to treatment, minors who are old enough to consent to their own treatment, have a right to confidentiality." Why would we ASSUME in the reading of the Stem that she can consent to her treatment at 15?? Since this is different in various jurisdictions. Are you advising on the the Test we assume a minor can consent even if Stem does not explicitly state this? and
2. As follow please to Sara's post in which she asks whether the general rule is that if the parents need to consent, we a required to inform them of crisis situations, however if the client is legally allowed to consent for themselves then we should maintain confidentiality and ask them if they would like to share the info??
Sorry I am confused by your explanation; can you please further elucidate what you mean.
Thank you very much.
Hi Jenn, This sample question is specific to California. In California, minors age 12 or older are able to consent to treatment. If there is a crisis situation and managing it involves informing parents, we would be permitted to break confidentiality regardless of the age of the minor. If you are in a different state, the laws will vary, so you would want to check with your local jurisdiction.
Hi Katie, This blog question is specific to California and the BBS licensing exam. If it were for the national exam, you would need to determine the state laws. In California, confidentiality and consent are separate issues and just because a parent consents to treatment of a minor 12 or older, they do not automatically have a right to information shared with the therapist.