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ED and the Social Work Exam

sexual dysfunctionLet's revisit the DSM for today's free practice question. Flipping randomly into the purple book, just as an exam item writer might, we land on the Sexual Dysfunctions chapter. Here are the disorders contained therein:

Delayed Ejaculation (what it sounds like)

Erectile Disorder (ditto--difficulty in obtaining or maintaining an erection during sexual activity)

Female Orgasmic Disorder (delay, infrequency, absence or reduced intensity of orgasm)

Female Sexual Interest/Arousal Disorder (what it sounds like)

Genito-Pelvic Pain/Penetration Disorder (persistent or recurrent difficulties with vaginal penetration)

Male Hypoactive Sexual Desire Disorder (More than six months of deficient or absent sexual/erotic thoughts and desire)

Premature (Early) Ejaculation (within 1 minute of penetration and before individual wishes it)

Substance/Medication-Induced Sexual Dysfunction (what it sounds like again)

Here's a sample question:

A client reports difficulty maintaining an erection when having sex with his wife ever since their honeymoon ended, a year ago. The problem occurs during what he describes as "vanilla" sex. As he reports details, the client seems fairly irritated, but not especially haunted by the issue. What set of specifiers is MOST appropriate to add to the diagnosis of erectile disorder:

A. Lifelong, situational, mild

B. Acquired, situational, mild

C. Lifelong, generalized, mild

D. Acquired, generalized, mild

What do you say?

This is one of those questions where you just need to know some definitions--or be able to suss them out with a little common sense. Here are the specifiers for erectile disorder:

Lifelong (present since the individual became sexually active)

Acquired (present after a period of relatively normal sexual function)

While we don't have details about the client's honeymoon or pre-marital sex life, we have to go with the contents of the question. Acquired is the better fit here. Hey, look, two answers already eliminated!

Generalized (not limited to certain types of stimulation, situations, or partners)

Situational (only occurs with certain types of stimulation, etc.)

The client's problems occur only during "vanilla" sex. We're quickly narrowed down to the answer. But we'll keep going. Mild, moderate, and severe are measures of the client's distress. Those specifiers don't describe symptoms, but the client's reaction to the symptoms. This client is irritated--a low level of distress. "Obsessed" or "unable to function" would be indicators of a more moderate or severe level of distress.

Also note, the problem has to have persisted for at least six months for a diagnosis of erectile disorder to be made.

TL;DR: Our answer is B, acquired, situational, mild.

For more reading about sexual dysfunctions in this chapter and beyond, take a look at:

And, of course, your DSM-5 is a friend as you prep DSM-5 questions--especially the desk reference edition.

For full-length practice tests covering the wide range of questions that can show up on the social work licensing exam (not just DSM!), sign up and create your exam bundle!

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Code of Ethics Review: Dating Colleagues and the Social Work Exam

social work colleague relationshipWe're working our way through the second section of the NASW Code of Ethics, a question at a time. For complete, 170-question exams covering ethics and much, much more, go here and build the exam bundle that best suits your study plan. Meanwhile, here's some free practice:

Working together at a residential facility, a therapist and case manager develop a strong attraction to each other. Both are social workers and want to be mindful of ethical guidelines as they begin to explore a relationship outside of work. Which of the following BEST describes NASW guidelines for relationships between social work colleagues?

A. The social workers can be in a romantic relationship as long as it's not sexual.

B. The social workers can be in a romantic relationship as long as they don't share clients.

C. The social workers can be in a romantic relationship as long as one isn't supervising the other.

D. The social workers can be in a romantic relationship as long as one transfers responsibilities to avoid making clients uncomfortable.

What do you say?

Let's take a look at the relevant section of the code, 2.07, Sexual Relationships. It says:

(a) Social workers who function as supervisors or educators should not engage in sexual activities or contact with supervisees, students, trainees, or other colleagues over whom they exercise professional authority.

(b) Social workers should avoid engaging in sexual relationships with colleagues when there is potential for a conflict of interest. Social workers who become involved in, or anticipate becoming involved in, a sexual relationship with a colleague have a duty to transfer professional responsibilities, when necessary, to avoid a conflict of interest.

After reading that, have you changed your answer?

The answer we like best is....C, the supervision one. You may be able to make an argument for some of the others, but that one's the strongest of the bunch. Let's take them one at a time:

A. This is a letter-of-the-code vs. spirit-of-the-code reading of 2.07. The code specifies a problem with "sexual relationships." Yes, okay. You could defend the answer in court. But you're not in court, you're preparing for the social work licensing exam. You want to choose the BEST of the offered answers, even when another answer seems acceptable. In this case, the answer that leaves no room open to interpretation is C, regarding supervision.

B. Sharing clients isn't mentioned in the code and, though that may get tricky between a therapist and case manager, it's not as tricky and ethically murky as answer C.

D. Avoiding client discomfort isn't mentioned in this section of the code. It's a nice thing to do. It's not as important here as avoiding the misuse of professional leverage.

Answer C is right from the code. And from most HR rule books. The key issue here is the exercise of professional authority. That may or may not be present in a therapist-case manager relationship, but it is certainly present in a supervisor-supervisee relationship. No sexual relationships between supervisors and supervisees. Simple as that.

You have your answer! You have your exam prep! If you encounter a question about this on the exam, you're ready for it. Good luck!

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Code of Ethics Review: Colleague Confidentiality vs. Impairment and the Social Work Exam

burnoutConfidentiality is likely to come up again and again as you prepare for the social work licensing exam. Most questions are likely to cover client confidentiality. If a client's family member calls to discuss the client, what is the best way for a social worker to proceed? Another therapist wants to discuss your former client's case--what then? After enough exam prep, these questions will become very familiar. (Hint: There's no confirming or denying that someone is a client, even to family or a former therapist.)

But how do you answer if you see something like this?

After a staff meeting, a clinician tells another social worker that she is "losing it...totally burnt out...I'm starting to hate my clients!" She says she's going to call in sick tomorrow and "get blackout drunk." What is the BEST course of action for the social worker to take regarding this colleague.

A. Discuss ways to cope with burnout other than binge drinking.

B. Consult with a supervisor regarding the clinician's confession.

C. Report the clinician's misconduct to the state licensing board.

D. Explore how the clinician's burnout is affecting her work with clients.

What do you think?

Let's do a decision tree. Two answers involve going to others--a supervisor or the state licensing board. The other two answers keep things between the clinician and the social worker. Let's look at the code for guidance.

2.02 Confidentiality
Social workers should respect confidential information shared by colleagues in the course of their professional relationships and transactions. Social workers should ensure that such colleagues understand social workers' obligation to respect confidentiality and any exceptions related to it.

This points to the not-going-to-others choices, A & D. But what about the hating clients? What about the blackout drinking? There's also this:

2.09 Impairment of Colleagues

(a) Social workers who have direct knowledge of a social work colleague's impairment that is due to personal problems, psychosocial distress, substance abuse, or mental health difficulties and that interferes with practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action.

(b) Social workers who believe that a social work colleague's impairment interferes with practice effectiveness and that the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.

The clinician is voicing psychosocial distress and a planned day of substance use/abuse. But still the code dictates first consulting with the colleague, not with others. There is an exception to this: If the colleague's impairment is undermining her work with clients (that is, her "practice effectiveness"), something more needs to be done. Is there a way to know whether that's happening here? Nothing in the stem is definitive. (Harboring hatred toward clients is part of burnout, not reportable impairment.) Are clients being negatively impacted? The first thing to do to find that out is ask. And, happily, one of the choices here--"Explore..."--has the social worker doing just that! Discussing coping skills, which may or may not be useful to the clinician, can wait. Our answer is D!

Want to read more on the topic? Take a look at these articles:

Better to spend your time on more practice questions! For additional questions covering the NASW Code of Ethics and lots more, sign up for SWTP full-length practice tests now!

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Code of Ethics Review: Respect Toward Colleagues and the Social Work Exam

respectEthics are in the daily spotlight these days. They're never out of daily consideration for practicing social workers. And ethics are even more front-burner for social workers preparing to pass the social work licensing exam. Let's dive back in where we left off months ago and take the second part of the NASW Code of Ethics section by section. Part two of the code covers SOCIAL WORKERS' ETHICAL RESPONSIBILITIES TO COLLEAGUES. Social work ethics don't end with your interaction with clients. Peers and co-workers are covered too! Like here in the first item, 2.01, Respect:

2.01 Respect

(a) Social workers should treat colleagues with respect and should represent accurately and fairly the qualifications, views, and obligations of colleagues.

(b) Social workers should avoid unwarranted negative criticism of colleagues in communications with clients or with other professionals. Unwarranted negative criticism may include demeaning comments that refer to colleagues' level of competence or to individuals' attributes such as race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical disability.

(c) Social workers should cooperate with social work colleagues and with colleagues of other professions when such cooperation serves the well-being of clients.

In a nutshell, be nice to your fellow social workers!

How might this material show up on the exam?

Imagine a question like this:

A client at an inpatient facility asks a veteran social worker if she can have her case transferred away from a young social worker at the facility. "He has no idea what he's doing," says the client. "He's like a chicken with its head cut off." The veteran social worker has observed the same thing. How should the veteran social worker proceed?

A. Let the client know she's seen the same behavior and follow facility rules regarding transfers.

B. Encourage the client to discuss her wants and needs with the new social worker.

C. Discuss the client's report with the new social worker and a supervisor.

D. Have the client's case transferred to the veteran social worker.

What do you say?

As usual, narrow it down. D. seems too abrupt (not enough respect). A. involves negative criticism of a colleague that may be accurate, but is unnecessary here (still not enough respect). C. would be a better answer if it didn't rope in a supervisor right away (show the colleague some respect--talk to him alone first). That leaves as the best of the offered answers B. Both the client and the anxious social worker may benefit from a discussion about the client's experience of treatment (respect for client and colleague).

It's all about respect!

As with many ethics-based questions on the exam, this isn't a slam dunk. It's not like a DSM question that you either know or you don't. But it's typical of the ASWB exam. You know a couple of answers aren't right and you end up stuck choosing between two that seem pretty good but not great. You take your best shot, you move on, you PASS the exam!

Good luck!

Start with SWTP's complete practice tests by building your own exam bundle here.

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Free Practice Question: Client's Previous Treatment Records

conferring with clinicianFrom the earliest days of SWTP, here's a question that never got included in an exam. It may have been too easy. We've toyed with it a little--made it a little trickier--and present here as another in our long series of free practice questions. Follow along on Facebook to see what others are saying. 

A client comes to a social worker for help with recurring bouts of depression. She's new in town, but has received therapy from a mental health clinic where she used to live. The client is not sure whether she's comfortable having the old and new clinicians communicating. In order to be MOST effective, the new social worker should:

A. Explore the client's discomfort with the communication before contacting the previous therapist.

B. Contact the client's previous therapist just once to discuss general impressions of the client.

C. Explain to the client that it will be easier to make progress with thorough information about prior treatment.

D. Ask the client to explain her reluctance to share information about her prior treatment.

What do you say?

Let's take the answers one by one:

A. may be appealing since it involves checking in with the client before reaching out to the prior clinician. But exploring isn't the same as getting permission. Without written consent, contacting the previous clinician violates the client's confidentiality.

B. has the same problem. Whether it's one contact or a thousand, no consent means no contact allowed.

C. While it may be true that more information equals more progress, the best, most effective of the choices offered here is...

D. Exploring the reluctance to share information about prior treatment is the best choice. Don't be fooled by "MOST effective." On the exam (as in practice!), abiding by the Code of Ethics is always the first priority.

So, breaking confidentiality? No good. Trying to get to comply and cooperate. Better, but still not great. Being where the client is, discussing her feelings, exploring her history--that's doing social work. The correct answer is D!

For more about client confidentiality, read up in the Code of Ethics and then in these articles, which each present different exam-like questions about client rights, records, and confidentiality:

Get started with full-length, real-time practice tests by signing up and building your own practice test bundle! Good luck on the exam!!!

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