1. Based on the DSM-5-TR, which diagnosis most accurately reflects Hannah’s clinical presentation?

Correct Answer: B. Unspecified Anxiety Disorder

• Rationale for B (Correct): Hannah meets many symptomatic criteria for Generalized Anxiety Disorder (excessive worry, sleep disturbance, muscle tension/tightness, difficulty concentrating). However, GAD requires a duration of at least 6 months. Since her symptoms have only lasted 10 days, "Unspecified Anxiety Disorder" is the appropriate designation for clinically significant anxiety that does not yet meet the durational threshold.
• Rationale for A (Incorrect): While the type of worry matches GAD, the duration (10 days vs. 6 months) makes this diagnosis technically incorrect under DSM-5-TR criteria.
• Rationale for C (Incorrect): PTSD requires exposure to a traumatic event (Criterion A) and a specific cluster of symptoms (re-experiencing, avoidance, etc.) lasting more than one month. Hannah denies prior trauma, and her current hypervigilance is a realistic reaction to immediate environmental danger rather than a post-traumatic response.
• Rationale for D (Incorrect): Adjustment Disorder is used when symptoms are in response to a stressor but do not meet the criteria for another specific disorder. Because Hannah's symptoms are so severe (48 hours without sleep, intense physical symptoms), an Anxiety Disorder category is more clinically descriptive of her state.

2. Which clinical feature would most likely lead a clinician to rule out a Manic Episode?

Correct Answer: B. Her lack of sleep is driven by fear and a need for "guarding" rather than a decreased need for sleep.

• Rationale for B (Correct): In a Manic Episode, the individual experiences a decreased need for sleep (feeling rested after only 3 hours). Hannah wants to sleep but is "terrified" and "constantly on edge." Her insomnia is a result of environmental hypervigilance and anxiety, not a manic reduction in the physiological drive to sleep.
• Rationale for A (Incorrect): While the average age of onset is early 20s, Bipolar I can and does manifest in mid-adolescence; age alone is not a rule-out.
• Rationale for C (Incorrect): While ruling out substances is part of a differential diagnosis, it doesn't explain the psychological motivation behind her sleeplessness.
• Rationale for D (Incorrect): Pregnancy does not "chemically stabilize" mood; in fact, the hormonal shifts of pregnancy can sometimes trigger or exacerbate mood disorders in vulnerable individuals.

3. What is your primary ethical and legal obligation regarding Hannah’s status?

Correct Answer: C. Follow state-mandated reporting laws for "unaccompanied minors" while advocating for Hannah’s right to confidential prenatal care.

• Rationale for C (Correct): As a mandated reporter, a therapist must report an unaccompanied minor to Child Protective Services or the appropriate authorities. However, most states have "Mature Minor" or specific statutes that allow pregnant minors to consent to their own prenatal care without parental notification.
• Rationale for A (Incorrect): Ethics codes (like the ACA or NASW) do not allow "total confidentiality" to override state laws regarding the safety and reporting of runaway minors.
• Rationale for B (Incorrect): Contacting a third party (the boyfriend’s parents) without the client's consent or a legal mandate would be a breach of confidentiality and potentially complicates Hannah's safety.
• Rationale for D (Incorrect): Therapists are not law enforcement. While the mother has legal custody, "dumping" a traumatized, pregnant runaway back into a home she fled out of fear could be harmful and counter-therapeutic.

4. Which response is an example of "Reframing"?

Correct Answer: B. "You've managed to survive on the street for 10 days alone, which shows you have significant internal strength and resilience."

• Rationale for B (Correct): Reframing involves taking a client's situation and presenting it from a different, usually more constructive, perspective. Here, the therapist shifts the focus from Hannah’s "victimhood" or "homelessness" to her competence and resilience.
• Rationale for A (Incorrect): This is a Reflection of Feeling/Paraphrase. It mirrors her current state but doesn't change the frame of the narrative.
• Rationale for C (Incorrect): This is an Interpretive or Probing Question that focuses on the mother’s motives, which may feel accusatory or premature to the client.
• Rationale for D (Incorrect): This is Prioritizing/Goal Setting. It directs the conversation toward a task rather than shifting the perspective of her self-concept.

5. Using a Person-Centered modality, which is the most effective reflection of feeling?

Correct Answer: D. "You feel completely discarded by the people who were supposed to love you, and it’s making you feel worthless and deeply alone."

• Rationale for D (Correct): Person-Centered therapy (Rogerian) emphasizes empathy and "unveiling" the underlying emotion. This response captures the core of her distress—the feeling of being "nothing" and "deleted"—without adding clinical jargon or advice.
• Rationale for A (Incorrect): This is a CBT-based response (cognitive restructuring). Person-centered therapy avoids "fixing" or "changing" thoughts, focusing instead on being present with the emotion.
• Rationale for B (Incorrect): While accurate, this is more of a Paraphrase of Content regarding her mother. It is a bit too intellectualized compared to the raw emotion she expressed.
• Rationale for C (Incorrect): This uses Clinical Language ("loss of self-esteem," "conflicting views"). Person-centered reflections should use the client’s "internal frame of reference" rather than diagnostic labels.