Crisis Management
During conjoint treatment, client Marlon (34) discloses that her father—also a participant in collateral sessions—has repeatedly said he will 'run over' her ex-partner if custody papers proceed. He names location and timing but later minimizes it as 'just talk.' What is the MOST defensible FIRST clinical action?
Your answer: TIMEOUT•Correct: B
Rationale: Ambiguous retraction does not negate risk. The therapist should perform and document a violence risk assessment promptly and activate protective actions if statutory/clinical thresholds are met.
Source: Tarasoff v. Regents of the University of California, 17 Cal.3d 425 (1976); Ewing v. Goldstein, 120 Cal.App.4th 807 (2004).
Report IssueClinical Law & Ethics
LMFT Thiago (42) is treating 17-year-old client Marie, who discloses during a session that she is pregnant and that the father is her 24-year-old boyfriend. Marie says the relationship is consensual and that she 'loves him.' Marie asks Thiago not to tell her parents. Under California mandatory reporting law, what is the MOST appropriate action?
Your answer: C•Correct: B
Rationale: Under California Penal Code Section 261.5, a minor under 18 cannot legally consent to sexual intercourse with an adult. A 24-year-old engaging in a sexual relationship with a 17-year-old constitutes statutory rape under California law, regardless of the minor's perceived consent or emotional investment in the relationship. As a mandated reporter, the LMFT must report suspected statutory rape — or any sexual activity between a minor and an adult — to Child Protective Services or law enforcement. Failure to report would constitute a violation of mandated reporter obligations.
Source: California Evidence Code §1014; California Welfare & Institutions Code §15630; 45 C.F.R. §164.502; 34 C.F.R. Part 99.
Report IssueClinical Law & Ethics
An LMFT is seeing a 45-year-old man with a history of bipolar I disorder, currently stabilized on lithium. The client reports that his psychiatrist recently left the practice and he has been without medication for three weeks. The LMFT has bipolar disorder treatment knowledge from continuing education and believes the client is stable enough to wait for a new psychiatrist. The client asks the LMFT to 'just prescribe something for now.' Under California law, what is the MOST appropriate action?
Your answer: C•Correct: B
Rationale: LMFTs in California are not authorized to prescribe or dispense medication — that authority rests with physicians and, in California, with nurse practitioners (with restrictions). The therapist must facilitate access to appropriate medical care while providing supportive therapy. Providing bridge prescriptions without prescribing authority violates scope of practice.
Source: California Evidence Code §1014; California Welfare & Institutions Code §15630; 45 C.F.R. §164.502; 34 C.F.R. Part 99.
Report IssueTreatment Planning
Danielle (36) arrives for the third session with her court-mandated 14-year-old son Zainab. Zainab has been resistant from the start. Danielle says, 'I don't believe in therapy. I believe in discipline.' Zainab rolls his eyes throughout the session. The therapist has attempted to engage both in a family session twice without meaningful progress. The therapist now suspects Danielle's resistance to the court-mandated process may be rooted in her own experience with systems of authority. What is the MOST appropriate systemic intervention?
Your answer: C•Correct: B
Rationale: Structural therapy prioritizes the parental subsystem before the child. Danielle's resistance to therapy — and possibly to authority more broadly — may be rooted in her own family history, her experience as a Black mother in systems that have historically marginalized her, or her own trauma. Meeting with Danielle alone allows the therapist to join with her, understand her worldview, and begin to address the subsystem that is maintaining Zainab's behavioral problems. Only after establishing a therapeutic alliance with Danielle can the family system be effectively restructured.
Source: AAMFT Code of Ethics §1.1; §3.7.
Report IssueClinical Law & Ethics
Subpoena Trap — An LMFT receives a civil subpoena for psychotherapy records with no client authorization and no court order. Opposing counsel threatens sanctions if records are not sent in 24 hours. What is the MOST appropriate FIRST response?
Your answer: D•Correct: B
Rationale: Subpoena alone generally does not override privilege for psychotherapy records. First step is to assert privilege/objection procedures and require valid legal authority before disclosure.
Source: California Evidence Code §1014; California Welfare & Institutions Code §15630; 45 C.F.R. §164.502; 34 C.F.R. Part 99.
Report IssueCrisis Management
In conjoint family therapy, one member reveals intent to assault a brother-in-law tonight if he appears at a funeral. Client then refuses further discussion. What is the MOST appropriate FIRST step?
Your answer: C•Correct: B
Rationale: Imminent, time-bound threats require immediate protective action; conjoint context does not nullify duty to protect.
Source: Tarasoff v. Regents of the University of California, 17 Cal.3d 425 (1976); Ewing v. Goldstein, 120 Cal.App.4th 807 (2004).
Report IssueClinical Law & Ethics
A therapist in a rural county is the only LMFT within 70 miles and is asked to treat a client's cousin, whom the therapist sees weekly at church. What is the MOST appropriate FIRST decision process?
Your answer: D•Correct: C
Rationale: Rural contexts may increase unavoidable overlaps, but they do not remove ethical duties. The key is documented risk management and ongoing boundary monitoring.
Source: California Evidence Code §1014; California Welfare & Institutions Code §15630; 45 C.F.R. §164.502; 34 C.F.R. Part 99.
Report Issue