ROC-MC Practice Test cheat sheet

Reliability = consistency of measurement; validity = accuracy in measuring the intended construct. A test can be reliable without being valid, but not valid without being reliable.

Standard error of measurement (SEM) = SD × √(1 − r); used to build confidence intervals around an obtained score (e.g., 95% CI ≈ score ± 1.96 SEM).

Criterion validity subtypes: concurrent (test vs. current criterion) and predictive (test vs. future criterion). Construct validity is supported by convergent and discriminant evidence.

DSM-5-TR substance use disorder requires ≥2 of 11 criteria within 12 months; severity: mild = 2–3, moderate = 4–5, severe = 6+.

Major depressive disorder requires ≥5 of 9 symptoms for ≥2 weeks, including depressed mood or anhedonia; excludes manic/hypomanic history.

Differential rule: 2–6 months of elevated mood = hypomanic (bipolar II); ≥7 days or hospitalization = manic (bipolar I). Cyclothymia = 2 years of subthreshold mood shifts.

Dementia vs. delirium: delirium has acute onset, fluctuating attention/awareness; major neurocognitive disorder has insidious, progressive decline.

Psychosis timeline: schizophreniform = 1–6 months; schizophrenia = ≥6 months including ≥1 month of active symptoms; brief psychotic disorder = <1 month.

Base rates affect diagnostic accuracy: low base-rate conditions produce many false positives even with high sensitivity and specificity; positive predictive value depends on prevalence.

Rogers' core conditions: unconditional positive regard, empathic understanding, congruence (genuineness); these are necessary and sufficient for therapeutic change.

Microskills hierarchy: attending behavior → open questions → paraphrasing → reflecting feeling → summarizing → confrontation; confrontation addresses discrepancies, not hostility.

Transference = client projects feelings about past figures onto counselor; countertransference = counselor's unresolved reactions to the client.

Immediacy = discussing the here-and-now of the counseling relationship; used to address ruptures, alliance strain, or process issues.

Working alliance (Bordin) has three components: goals, tasks, and emotional bond; alliance is a consistent predictor of outcome across orientations.

Ethical bracketing/self-disclosure rule: disclose only when it serves the client's clinical interest, is brief, and is clinically processed afterward.

Empathy types: cognitive (perspective-taking), affective (shared feeling), and compassionate (motivation to help); accurate empathy is a trainable microskill.

Silence is a therapeutic intervention: it allows processing, emotional expression, and client-led pacing; overuse can increase anxiety.

SMART goal criteria: Specific, Measurable, Achievable, Relevant, Time-bound; each treatment plan objective should map to an assessment finding.

CBT cognitive model: situation → automatic thought → emotion/behavior; interventions include cognitive restructuring, behavioral experiments, and thought records.

Exposure hierarchy uses SUDS ratings (0–100); graded in-vivo exposure starts at 40–50 SUDS and progresses as habituation occurs.

Behavioral activation targets avoidance and reinforcement loss in depression by scheduling mastery and pleasure activities.

DBT four modules: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness; individual therapy + skills group + phone coaching + consultation team.

Motivational interviewing: OARS (open questions, affirmations, reflections, summaries); rolling with resistance rather than confronting it.

Stages of change (Prochaska): precontemplation, contemplation, preparation, action, maintenance, (termination); interventions match stage.

Relapse prevention (Marlatt): identify high-risk situations, coping skills, and lapse vs. relapse distinction; a lapse is not treatment failure.

Informed consent elements: nature of treatment, risks/benefits, alternatives, right to withdraw, confidentiality limits, fees, and counselor qualifications.

Tarasoff duty to protect arises when a client poses serious danger to an identifiable third party; actions include warning, notifying police, or hospitalization per jurisdiction.

Mandatory reporting: suspected child abuse/neglect, elder abuse, and dependent adult abuse must be reported regardless of confidentiality.

Confidentiality exceptions: imminent danger, abuse reporting, court order, and client waiver; HIPAA governs protected health information in covered entities.

Multiple relationships: avoid when exploitation risk exists; not all are unethical (e.g., attending a community event), but romantic/sexual relationships with clients are prohibited.

Competence boundaries: practice within education, training, supervised experience, and state licensure scope; obtain consultation or referral when outside scope.

Records retention: keep clinical records per state law and payer requirements; typically 5–7 years after termination, longer for minors (until age of majority plus retention period).

Ethical decision models (e.g., ACA, APA) share steps: identify the problem, consult codes/laws, consult colleagues, consider consequences, act, document.

Cultural humility (Tervalon & Murray-García) = lifelong self-reflection, redress of power imbalances, and institutional accountability; distinct from static cultural competence.

Microaggressions: microassault (deliberate), microinsult (unintentional demeaning), microinvalidation (dismissing experience).

Intersectionality (Crenshaw) = overlapping identities (race, gender, class, disability) shape unique experiences of privilege and oppression.

Acculturation strategies (Berry): integration, assimilation, separation, marginalization; integration is generally associated with best adjustment.

Cultural formulation interview (DSM-5-TR CFI) explores cultural identity, explanations of illness, stressors/supports, and clinician-client relationship factors.

Racial/ethnic identity models (e.g., Cross, Helms) describe stage progression from internalized oppression to internalized racial identity; stage affects counseling process.

Language access: use qualified interpreters, not family members, for clinical communication; document interpreter use.

Implicit bias affects diagnosis and referral; use structured assessment and decision checklists to reduce disparate impact.

Internal validity threats: history, maturation, testing, instrumentation, regression to the mean, selection, attrition, and mortality.

Random assignment controls selection bias and supports causal inference; random selection supports generalizability.

Effect size conventions (Cohen): d = 0.2 small, 0.5 medium, 0.8 large; r = 0.1, 0.3, 0.5.

Power increases with larger sample, larger effect size, lower alpha, and lower variability; power = 1 − β (β = Type II error).

Type I error = rejecting a true null (alpha); Type II error = failing to reject a false null (beta).

Program evaluation models: needs assessment, process/formative, outcome/summative, cost-benefit/cost-effectiveness; logic models link inputs → activities → outputs → outcomes.

Qualitative rigor: credibility, transferability, dependability, confirmability (Lincoln & Guba); triangulation strengthens credibility.

Test score interpretation: z = (X − M)/SD; T = 50 + 10z; percentile rank reflects percentage of scores at or below a given score.

Holland's RIASEC types: Realistic, Investigative, Artistic, Social, Enterprising, Conventional; congruence between person and environment predicts satisfaction.

Super's life-span, life-space theory: self-concept develops through career stages (growth, exploration, establishment, maintenance, decline).

Krumboltz's social learning theory: happenstance, self-efficacy beliefs, and learning experiences shape career decisions.

Gottfredson's circumscription and compromise: children narrow career options by gender and prestige, then compromise on interests.

Career assessment tools: Strong Interest Inventory (RIASEC-based), Self-Directed Search, Myers-Briggs Type Indicator (not career-specific), Work Values Inventory.

Career decision-making difficulties include indecision (developmental) versus indecisiveness (pervasive, anxiety-related).

Social cognitive career theory (Lent, Brown, Hackett): self-efficacy, outcome expectations, and goals mediate career choice.

Dual-career and work-family issues: role conflict, spillover, and boundary management affect career development and satisfaction.

Supervision models: developmental (e.g., Stoltenberg's IDM stages: novice, advanced beginner, competent, proficient, expert), integrative, and discrimination model (Bernard: intervention, conceptualization, personalization).

Discrimination model roles: teacher, counselor, consultant; supervisor chooses role based on supervisee need and task.

Supervision contract should specify goals, methods, evaluation criteria, confidentiality limits, and due-process/grievance procedures.

Gatekeeping: supervisors have an ethical duty to remediate or dismiss supervisees who are unsuitable for professional practice.

Live supervision, bug-in-ear, and recorded sessions provide direct observation; self-report alone is less reliable.

Consultation models: client-centered (process), consultee-centered (skill/knowledge/confidence), program-centered, and administrative.

Consultant role: collaborative problem-solving; consultant lacks direct authority over consultee's client, unlike supervision.

Continuing education and licensure renewal require documented CE hours; supervision of post-degree hours varies by state (typically 1,500–3,000 hours).