Well, folks, this week's LCSW practice exam question means we've officially made it halfway through our list of Hot Topics! This week we tackle Assessment. The word itself is complex; it can refer to an individual document, a test, a process, or an entire segment of the treatment process. Ideally, you are assessing your clients on some level during every session, although the quality of this assessment changes over time. So, how does this topic come up in test items? Let's look at a sample.
A 43 year-old woman begins working with a therapist, reporting significant issues in both her personal and professional relationships that have begun over the past month. During the initial session, the therapist has difficulty following the client's train of thought, and despite several redirections, cannot keep the client focused on the question or topic at hand. Which category in the mental status exam BEST captures these observations?
A. Thought Content
B. Abstract Thinking
Even though it will give the answer away, let's go through each of the answer categories in the LCSW practice exam question above and consider them. So what's covered under Thought Content? A therapist might record things like delusions, general paranoia, and preoccupations in this category. You could think of this simply as "what the person is thinking about." How about Abstract Thinking? This is always one that I need reminders on, because sometimes it can be tricky for me to recognize. Abstract thinking is the ability to see a specific example of something and draw from it a general principle that can be applied to other situations. The classic way to test this in the mental status exam is through the use of familiar proverbs ("Don't look a gift horse in the mouth"). If the client explains the meaning of this proverb literally (like saying that the proverb means you shouldn't look animals in the eye), it tells you that their abstract thinking is compromised. Moving on to Associations: this is a category where you use the client's flow of speech to understand their flow of thoughts. Things like flight of ideas (bouncing from one topic to another with no logical connection) and tangential speech (answers that don't relate to the question asked) are captured in this category. Finally, let's look at Perceptions. This category tries to assess the accuracy of the person's senses (Do they hear things accurately? Do they see what's presented to them?). This is the category in which hallucinations or illusions would be evident.
I'm hoping it comes as no surprise that the correct answer is C, Associations. The stem refers to a person who is exhibiting flight of ideas and tangential speech, both of which indicate a problem with the flow of the client's thoughts (this may be why she's having relationship issues). While there's no guarantee that the mental status exam will come up on YOUR exam, understanding and utilizing these categories can give you important information about your clients and can occur without using any kind of formal instrument -- most of it only requires that you be observant during interactions.
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Coming up next week: Interventions