At BTA we often hear of confusing, misleading rumors that circulate widely among exam candidates. Not only are these rumors often very anxiety provoking, but they can also significantly interfere with effective exam preparation.

BTA's new Myth Buster was designed to help debunk the myths and replace them with solid, accurate information that can be supported by factual evidence. If you think you have come accross one of these myths and you want us to investigate it, please write to us at btatraining@att.net.

Here are a few examples...

Dear BTA,

I've heard from (another company) that the license exam is full of "trick questions" and that I should be prepared for such deception and manipulation when I take my exam. Is that true?

Frightened in Fresno


Dear Frightened,

The BBS does its best to avoid trick questions. Keep in mind that the Subject Matter Experts (question writers) are licensed clinicians in your field and when they are trained to do their job, they are specifically and repeatedly told not to write trick questions. In fact, we've spoken to several of these question writers over the years. They have all clearly recognized the importance of avoiding "trick questions."

For more "in depth" information about this issue, read on.

A "trick question" is one that intentionally leads a test taker to choose an incorrect answer based on a trivial detail that is irrelevant to the purpose of the examination. Here's an example...

Q: Your client has experienced panic attacks over the past three months. Which is his most likely diagnosis?

a. Panic Disorder
b. Specific Phobia
c. Somatoform Disorder
d. Dysthymia

Technically speaking, there is no diagnosis called "Panic Disorder." The correct, full name is "Panic Disorder with (or without) Agoraphobia." There is, however, an anxiety related diagnosis correctly called "Specific Phobia." Therefore, B would appear to be the best answer simply and only because A would have to be ruled out. However, if the BBS determined that B is the correct answer, then this would be a trick question.

The BBS question writers know that if we ignore the trivial technicality regarding the name "Panic Disorder," then both answer A and answer B are correct. Panic attacks can occur in any anxiety disorder. A panic attack is simply an discrete episode of intense anxiety, with physical symptoms of anxiety that peak within 10 minutes. It's the uncued or untriggered panic attacks that occur in Panic Disorder, but triggered panic attacks can and often do occur in any anxiety disorder. The question stem does not make this distinction.

Considering the goal of the license exam is not to test your ability to catch trivial technicalities in license exam questions but rather your ability to practice competently, this type of "trick question" would not appear on your test. The BBS question writers do not render an answer incorrect simply by virtue of a trivial technicality.

To the unprepared exam candidate, the following question (which could show up on your exam) may likewise appear to be a "trick question," however this one is not.

Q: For the past three months your client has experienced a condition characterized by triggered panic attacks. Which is his diagnosis?

a. panic disorder
b. specific phobia
c. somatoform disorder
d. dysthymia

This time B is the correct answer and the only correct answer even if one were to ignore the fact that answer choice A does not use the precise wording of the DSM's name for "Panic Disorder with (or without) Agoraphobia."

In this case, B is the correct answer due to an important distinction that is prompted by information in the stem of the question. The question stem refers to "triggered panic attacks" which are the defining feature of Specific Phobia. Panic attacks that are experienced in the course of a Panic Disorder must be untriggered.

Some people might mistakenly think of this as a "trick question" and might get caught up in trivial details, but the question is designed to test your knowledge of the diagnostic significance of distinguishing triggered from untriggered panic attacks. Only someone who is not aware of this distinction would see this as a "trick question."

Similarly, it is not a trick question if it requires you to distinguish between...

• illusions and delusions
• obsessions and preoccupations
• ideas of reference and delusions of reference
• schizoid and schizotypal
• confidentiality rules in a public setting vs. confidentiality rules in a private practice

These distinctions have important implications for clinical practitioners and their clients. If exam questions ask you to make such distinctions it's not because you're being tricked...it's because it's the BBS's job to determine your level of clinical knowledge and skill.

Here's the danger of expecting "trick questions." Test takers who expect "trick questions" are inclined to reject an obviously correct answer in favor of an incorrect answer. For example....

Q: Your client reports that, in several settings, he has been smelling noxious fumes that nobody else smells. Your client should probably be treated for...
a. dissociative fugue
b. a physical condition
c. panic disorder
d. adjustment disorder

This is not a "trick question." Hallucinations of smell (known as olfactory hallucinations) are almost always caused by physical conditions or intoxication. If, because you were aware of that fact, answer B seemed obvious to you, but you were expecting a trick question, you might say to yourself "no, B couldn't be the correct answer. It seems to obvious, I must be missing something." You would like be able to confidently rule out panic disorder and adjustment disorder, which would leave you with dissociative fugue. Not so confident in your knowledge of the criteria for dissociative fugue, you may be inclined to choose answer A in place of the correct answer.

If you don't expect trick questions you won't make that kind of mistake.

Dear BTA,

I was taught (and I have this in writing from another exam prep company) that when a client is a minor, the minor holds the privilege. But my supervisor says that's not always true. Which is it?

Upholding the Law, in Laverne


Dear Upholding,

Your supervisor is right. Some exam preparation companies oversimplify an issue, and simple seems comforting to a lot of exam candidates. But it won't always get you to the correct answer on an exam question.

Sometimes a minor client is the holder of the privilege, and sometimes not. In any particular case the issue may depend on whether or not...

• the minor has a guardian
• the guardian is a parent, attorney serving as guardian ad litem, or a court appointed special advocate
• the parent/guardian has abused the minor
• the minor is of "sufficient age and maturity" to serve as the holder of the privilege
• the minor is under the age of 16, has been the victim of a crime, and disclosure is in the best interest of the child
• the minor's treatment is based on parental consent or minor consent to treatment

It's comforting to know that the law doesn't expect a 5 year old psychotherapy client to make decisions about whether or not to exercise the privilege.

For more "in depth" information about this issue, read on.

Don't just take our word for it. Here's what the law says.

CA Evidence Code, Sec. 1013. "Holder of the privilege"

As used in this article, "holder of the privilege" means:
(a) The patient when he has no guardian or conservator.
(b) A guardian or conservator of the patient when the patient has a guardian or conservator.
(c) The personal representative of the patient if the patient is dead.

"Guardian," in the context of this law, doesn't necessarily mean the child's parents. The court could appoint others to serve as the minor's guardian for purposes of exercising privileged communication on behalf of the minor. For example, Welfare and Institutions Code section 326.5 provides that a dependent child's guardian ad litem "may be an attorney or a court-appointed special advocate..."

Then there's California Welfare and Institutions Code Section 317, subdivision (f) which states:

Either the child or the counsel for the child, with the informed consent of the child if the child is found by the court to be of sufficient age and maturity to so consent, may invoke the psychotherapist-client privilege, physician-patient privilege, and clergyman-penitent privilege; and if the child invokes the privilege, counsel may not waive it, but if counsel invokes the privilege, the child may waive it. Counsel shall be holder of these privileges if the child is found by the court not to be of sufficient age and maturity to so consent...."

Also note the California Evidence Code Section 1027 which states...

"Privilege nonexistent; patient child under 16 or victim of crime: There is no privilege under this article if all of the following circumstances exist:
(a) The patient is a child under the age of 16.
(b) The psychotherapist has reasonable cause to believe that the patient has been the victim of a crime and that disclosure of the communication is in the best interest of the child.

This section of the law means that sometimes neither the minor nor his/her parents are the "holder of the privilege." It means that in such circumstances there is no privilege and the therapist may reveal information that is in the best interest of the child....but only when these conditions are met.

These are just a few of many situations in which the minor is not the holder of the privilege.

There are also situations in which the minor is the holder of the privilege. For example, when treatment is based on the legitimate consent of a minor, age 12 or older, then that minor is entitled to the same confidentiality and privileged communication rights as an adult client would be entitled to.

Then there was the "Daniel C.H." case in which the father was accused of child molest. Here is what the court had to say. "We believe that in a case such as this, where the father is accused of child molest, and the child is in therapy, presumably to deal with the emotional aftermath of the alleged molest, the accused parent should not be entitled to access to the communications made by the child to the therapist. The child has at stake a substantial privacy interest, and we can foresee substantial emotional harm to the child from a forced disclosure in these circumstances....We believe that the privilege belongs to the child, as the patient." Note that the court's decision in this kind of a case certainly does not apply to all cases.

Like so many legal issues, identifying the "holder of the privilege" is not a simple and straight forward matter. Complex legal issues, such as conflict of laws, are beyond the scope of practice of psychotherapy professions, and beyond the scope of competence of most psychotherapists. Social Workers and MFT's are only expected to understand the more simple, straightforward matters and are expected to consult an attorney in a specific case if the issue is anything other than that. The good news is that license exam questions usually avoid anything that would require an attorney's consultation. When those issues do arise in an exam question, the correct answer is likely to be "consult an attorney." The wrong answer would be to oversimplify by simply saying "a child client is the holder of the privilege."