3- Clinical Psychology Flashcards
You are seeing a family consisting of a mother, a father, and a daughter in therapy. Every time the mother says something, the father and the daughter argue with whatever she says. The behavior of the father and the daughter can be best described by the term Select one: A. triangulation. B. fusion. C. coalition. D. joining.
Correct Answer is: C
All of these choices sound good, so to answer the question, you have to understand what each of these terms mean in the language of family therapy, and also not miss the fact that the question is asking about the behavior of the father and the daughter (as opposed to the behavior of the father and the mother). In family therapy, the term coalition refers to an alliance of two family members against a third. According to Minuchin, dysfunctional families are sometimes characterized by stable coalitions of a parent and a child against the other parent.
The other terms in the question don’t apply to the behavior of the father and the daughter. Triangulation refers to a situation in which another family member is brought into a conflict that actually exists only between two members, such as when two parents constantly try to get their child to take their side in a conflict the parents are having with each other. Fusion, a term used by Bowen, refers to an inability to separate intellectual from emotional functioning, or an inability to separate one’s own thoughts and feelings from those of other family members. And joining is a technique described by Minuchin that involves adopting the family’s affective style in order to help establish a working relationship, gain greater understanding of the family structure, and gain more leverage in bringing about family change.
Additional Information: Theoretical Constructs: Structural Family Therapy
All of the following statements are consistent with Minuchin’s concept of enmeshed or disengaged families, except:
Select one:
A. in an enmeshed family, parents may devote an excessive amount of attention to one symptomatic family member who serves as the “symptom bearer” for the entire family.
B. enmeshed parents tend to be loving and considerate and do a lot for their children.
C. in a disengaged family, excessive conflict prevents effective communication.
D. in a disengaged family, parents may not notice when their children need support or guidance.
Correct Answer is: C
According to Minuchin, boundaries in a family system can be described as enmeshed or disengaged; the two terms represent opposite ends of a continuum. Enmeshed boundaries are overly diffuse; the result is a family in which members are overly close and dependent. Disengagement describes boundaries that are overly rigid; members of a disengaged family tend to be isolated from each other.
in a disengaged family, excessive conflict prevents effective communication.
Contrary to this choice, members of disengaged families tend to avoid conflict. The other choices are true of enmeshed or disengaged families.
Additional Information: Theoretical Constructs: Structural Family Therapy
The techniques of "externalizing" a problem, relative influence questioning, and bringing an "outside witness" into the therapy session are most associated with Select one: A. Structural Therapy B. Systemic Therapy C. Dialectical Behavioral Therapy D. Narrative Therapy
Correct Answer is: D
Narrative Therapy is premised on the notion that our identities are based on the stories we tell ourselves about our lives, or our narratives. Narrative therapists work to help people (they reject the term “client’) fully describe these stories, and restructure and reframe their stories and thereby their identities. The therapist adopts a co-operative and egalitarian stance, and works to help the person discover his own narrative rather than imposing one. Some techniques associated with Narrative Therapy include 1) naming the problem, which encourages focus, precision, and control; 2) externalizing the problem, which involves framing the problem as having an effect on, rather than being within, the person (e.g., “depression invaded your life”), the goal being to separate the problem from the person’s identity; 3) relative influence questioning, which involves contrasting the effect the problem has had on the person’s life with the effect that the person’s life has had on the problem (i.e., the control over the problem the person has had); 4) deconstructing unique outcomes, whereby the therapist encourages the person to focus and expand on experiences that are not consistent with a problem-saturated narrative; and 5) outsider witness, in which a third party is brought into the therapy session and the person tells this witness his revised or developing life narrative. Therapy ends when the person’s story is revised to the point that it is rich enough to sustain a healthy future.
Additional Information: Narrative Therapy
What type of therapy is being practiced if a psychotherapist uses a method called WDEP to teach a patient new ways of coping? Select one: A. Cognitive therapy B. Family systems therapy C. Rational emotive behavioral therapy D. Reality therapy
Correct Answer is: D
The WDEP system is a feature of Reality Therapy, developed by Glasser and based on Choice theory. In Reality Therapy, the emphasis is on personal responsibility and balance of five basic needs: survival (i.e., breathing, digesting, and sweating); to love and belong (i.e., need for friends and family); power (i.e., self-esteem, recognition, and competition); freedom (i.e., make choices); and fun (i.e, play, laughter, learning, recreation). Reality therapy uses questioning techniques and the WDEP system provides a questioning framework with each letter representing an identifying idea: W - exploring the client’s wants and perceptions, D - direction or what client is doing (acting, thinking, feeling, physiology) to get what they want, E - evaluate whether client’s behavior is getting him/her closer or further from goal, and P- planning or creating and implementing a workable plan to make positive changes. Other techniques used in this therapy include role playing, the use of humor, confronting the client, and helping the client formulate plans.
A prominent politician who has advanced his career by strongly denouncing homosexuality and rights for gay people is caught engaging in a homosexual act in a public bathroom. From the perspective of psychoanalytic theory, the politician's fierce condemnation of homosexuality would have been a sign of Select one: A. repression. B. denial. C. reaction formation. D. sublimation.
Correct Answer is: C
In psychoanalytic theory, defense mechanisms function outside of conscious awareness to reduce anxiety caused by unconscious conflicts or external threats to the ego. Both healthy and neurotic people employ defense mechanisms; they only become a problem if the ego relies on them excessively or inflexibly. Anna Freud described and classified different types of defense mechanisms. In reaction formation, one perceives an anxiety-provoking impulse or feeling as its opposite, such as by turning love into aggression, aggression into love, or a wish into a fear. A psychoanalyst might say that the politician is using reaction formation to transform unacceptable homosexual impulses into the opposite feeling of fierce opposition to it. Regarding the other choices, repression, the most basic defense mechanism, involves excluding an unacceptable impulse from consciousness. In denial, the person rejects a threatening fact that is true, even in the face of overwhelming evidence to support it. It is common in addiction, in which the people commonly deny the seriousness of the problem. And in sublimation, the person rechannels socially unacceptable impulses into socially useful activity, such as art or work; this is considered the healthiest and most successful defense mechanism.
Additional Information: Defense Mechanisms
Which of the following statements is true regarding electromyograph (EMG) biofeedback?
Select one:
A. It is more effective in treating tension headaches than migraine headaches.
B. It is more effective in treating migraine headaches than tension headaches.
C. It is equally effective in treating tension headaches and migraine headaches.
D. It is ineffective in treating tension and migraine headaches.
Correct Answer is: A
Overall, biofeedback works equally well for tension and migraine headaches. However, a different modality of biofeedback is used for each of these conditions. EMG biofeedback, in which the person is trained to decrease muscle tension of the facial and/or neck muscles, is the most commonly used modality for biofeedback treatment of tension headaches; this is why “more effective in treating tension headaches than migraine headaches” is the best answer. For migraine headaches, thermal hand warming biofeedback, whereby the person is trained to warm his or her hands, is the most commonly used modality.
Additional Information: Headaches
Ethnic minority clients with a strong affiliation with their own culture tend to
Select one:
A. not benefit from therapy.
B. drop out of therapy prematurely.
C. prefer ethnically similar therapists and counselors.
D. respond to therapy in the same way as non-minority clients, regardless of the therapist.
Correct Answer is: C
Research supports the notion that ethnic minority clients with a strong affiliation with their own culture tend to prefer ethnically similar counselors, and some research show that outcome for such clients is better when the counselor is ethnically similar.
Additional Information: Therapist-Client Similarity
The concept "collaborative empiricism" is affiliated with which of the following theorists? Select one: A. Perls B. Freud C. Ellis D. Beck
Correct Answer is: D
Collaborative empiricism is a central technique of Beck’s cognitive-behavioral therapy and refers to the therapist and client working together to gather evidence and test the logic, or hypotheses, of the client’s thoughts and beliefs.
Additional Information: Introduction (Beck’s Cognitive Therapy)
When working with ethnically, linguistically, and racially diverse populations, a therapist should emphasize:
Select one:
A. acculturation
B. client’s individual goals
C. the political, social, and economic affects on mental health
D. which stage of identity development the client is in
Correct Answer is: B
Although all of the choices offered are important to consider when working with diverse populations, a therapist should not “emphasize” any of the choices other than the client’s individual goals.
Additional Information: Multiculturalism
Which of the following is not a characteristic of Western culture-bound values?
Select one:
A. cause-effect approach
B. openness and intimacy
C. clear distinction between mental and physical well-being
D. strict adherence to a schedule
Correct Answer is: D
Sue and Sue (1999) described three premises from the Western perspectives of counseling, based on the assumption of individualism, that can have an effect on the therapeutic relationship. They are identified as class-bound values, culture-bound values and language variables. Class-bound values include valuing of time boundaries or a strict adherence to time schedules, an ambiguous and unstructured approach to problem solving, and the emphasis on long- range goals and solutions. Culture-bound values focus on individualism versus collectivism, cause and effect relationships for client problems, emphasis on emotional/verbal expressiveness, active participation and openness to discussing intimate aspects of the client’s life, and the separation of physical and mental well-being* (which makes these options incorrect). Language variables are those in which standard English and verbal communication are stressed.
Which of the following would most likely be the focus of an object-relations therapist?
Select one:
A. communication skills training and facilitating catharsis
B. paradoxical interventions and circular questioning
C. helping the client identify introjects and providing support
D. exploring intergenerational transmission processes and cognitive restructuring
Correct Answer is: C
There are a variety of object-relations theories and therapies based on them. However, most focus on how introjects, or internalized images of significant others from the past, affect our current relationships and functioning. In addition to helping clients identify introjects, an objects-relations therapist would be likely to provide support and “re-parenting,” in order to help the client develop new, healthier introjects.
Additional Information: Object-Relations Theory
In group therapy, which of the following situations is most likely to increase a given member’s self-disclosure?
Select one:
A. the group leader has made it clear that self-disclosure is expected
B. a temporary and uncomfortable silence has pervaded the group
C. other members of the group have freely self-disclosed
D. the group consists solely of verbal and intelligent individuals
Correct Answer is: C
This question is actually about social psychology as much as it is about group therapy. Research in social psychology has illustrated that we are more likely to talk openly about ourselves after someone else opens up about him or herself. This phenomenon has been termed “self-disclosure reciprocity.”
Additional Information: Reciprocity
Relying on the work of Heinz Kohut, a therapist would stress the use of which of the following when working with a narcissistic client? Select one: A. coaching B. empathy C. congruence D. interpretation of drives
Correct Answer is: B
According to Kohut, a consistent lack of parental empathy is what leads to narcissism in a child in the first place. Therefore, to help the narcissistic client develop a more healthy, cohesive sense of self, the therapist must provide empathy.
Additional Information: Heinz Kohut
A minority group member who is a client of yours expresses very strong negative feelings towards her own culture in a therapy session. This client is most likely in which stage of the Minority Identity Development model developed by Atkinson, Morten, and Sue? Select one: A. resistance B. dissonance C. conformity D. denial
Correct Answer is: C
The authors mentioned in the question have developed a model of cultural identity development in minority group members, called the Minority Identity Development (MID) model. The model’s five stages are conformity, dissonance, resistance and immersion, introspection, and synergetic articulation and awareness. Individuals in the conformity stage prefer the dominant culture’s values to those of their own culture. They are likely to have feelings of racial self-hatred, negative beliefs about their own culture, and positive feelings toward the dominant culture.
Additional Information: Minority Identity Development Model
Troiden’s (1989) model of homosexual identity development indicates:
Select one:
A. females typically realize that they are homosexual at a younger age than males.
B. females and males typically realize they are homosexual at about the same age.
C. males typically begin to “come out” as homosexual at a younger age than females.
D. males and females typically begin to “come out” as homosexual at about the same age.
Correct Answer is: C
Troiden’s model distinguishes between four age-related stages: sensitization, identity confusion (self-recognition), identity assumption, and identity commitment. Sensitization begins before puberty and consists of homosexual feelings or experiences without an understanding of them in terms of self-identity. Identity confusion, sometimes referred to as self-recognition, is when an individual realizes that he or she may be homosexual. This usually develops in adolescent males around 17 years and in females around 18 years of age. During identity assumption, the individual comes out as a homosexual - typically from 19-21 years for males and 21-23 for females. Identity commitment is characterized by the individual adopting a homosexual lifestyle - which usually occurs from 21-24 years for males and 22-23 for females.
Additional Information: Troiden’s Model of Homosexual Identity Development
According to recent outcome studies, which of Yalom's therapeutic factors is the most direct indicator of group outcome success as well as growth within the individual group members? Select one: A. catharsis B. collusion C. cohesion D. universality
Correct Answer is: C
Recent studies indicate cohesiveness in a group, characterized by warmth and acceptance, self-disclosure and risk-taking behavior, freedom to express feelings openly (both positive and negative) is most associated with group member improvement and outcome success. As Yalom described, the therapeutic factors do not occur in isolation - they are interdependent and group cohesion serves as a necessary precondition for the other factors. Early confrontation, later positive alliance, later affective confrontation and fewer leader interventions in later sessions are also associated with successful group outcomes. (See: Burlingame, G.M., MacKenzie K.R., Strauss B. (2004). Small group treatment: evidence for effectiveness and mechanisms of change. In: Lambert, M., editor. Bergin and Garfield’s handbook of psychotherapy and behavior change. 5th ed. New York: John Wiley and Sons Inc, 647-96.)
Additional Information: Benefits of Group Therapy
Which of the following statements is most consistent with Troiden’s (1989) model of gay and lesbian identity development?
Select one:
A. Identity confusion and identity assumption begin somewhat earlier for females than males, but identity commitment begins earlier for males than females.
B. Identity confusion, identity assumption, and identity commitment begin somewhat earlier for males than females.
C. Identity confusion, identity assumption, and identity commitment begin somewhat earlier for females than males.
D. There are no gender differences in the age of onset for homosexual identity development.
Correct Answer is: B
Troiden’s (1989) model of homosexual identity development describes four stages: Sensitization, identity confusion, identity assumption, and identity commitment. Sensitization begins before puberty and consists of homosexual feelings or experiences without an understanding of them in terms of self-identity. Identity confusion, which usually develops in adolescent males around 17 years and in females around 18 when they realize that they may be homosexual. During identity assumption, the individual comes out as a homosexual - typically from 19-21 years for males and 21-23 for females. Identity commitment is characterized by the individual adopting a homosexual lifestyle - which usually occurs from 21-24 years for males and 22-23 for females [The formation of homosexual identities, Journal of Homosexuality, 17(1/2), 43-73].
Additional Information: Troiden’s Model of Homosexual Identity Development
When a psychologist takes a phenomenological approach, this means that she focuses on Select one: A. unconscious determinants of behavior. B. subjective experience. C. behavioral antecedents of behavior. D. self-actualization.
Correct Answer is: B
The term phenomenology refers to subjective experience. Phenomenology formed the basis of person-centered psychotherapy, the school of psychotherapy founded by Carl Rogers. He was influenced by the work of Combs and Snygg, who defined the “phenomenal field” as “the entire universe, including himself, as it is experienced by the individual at the instant of action…it is the universe…in which each individual lives, the everyday situation of self and surrounding which each person takes to be reality.” Rogers believed that the therapist’s goal was to get closer to this phenomenal field; his method included listening to the person’s report of recent subjective experiences, and paraphrasing or rephrasing these reports. Rogers also believed that self-actualization was a goal of therapy, but the term phenomenology refers to subjective experience, not self-actualization.
Additional Information: Client-Centered Therapy
Irvin Yalom concludes that, unless careful selection criteria are used, the majority of group therapy patients may drop out of therapy discouraged and without benefit. He also proposes that the most important criterion for deciding who to include in group therapy is: Select one: A. willingness to learn from others. B. previous group experience. C. motivation. D. psychological mindedness.
Feedback
Correct Answer is: C
Yalom argues (and the research backs him up) that group therapy patients must be highly motivated not only for therapy in general but also for group therapy in particular.
Additional Information: Composition of Groups
Eysenck’s 1952 study on psychotherapy outcome:
Select one:
A. concluded that individuals who receive psychotherapy are better off than 80% of controls
B. concluded that psychologists and psychiatrists are more effective than master’s level clinicians
C. challenged the effectiveness of most psychotherapy treatments
D. led to many other outcome studies, most of which have supported his findings
Correct Answer is: C
Eysenck, in his 1952 study, found that 64% of patients in eclectic therapy and 44% of psychoanalytic patients improved versus a 72% improvement rate for untreated patients. His methodology and findings have been criticized for decades following his report and most studies since then have found psychotherapy to be superior to no treatment.
concluded that individuals who receive psychotherapy are better off than 80% of controls
This choice is one of the conclusions of Smith and Glass’ (1978) meta-analysis.
concluded that psychologists and psychiatrists are more effective than master’s level clinicians
This was not one of Eysenck’s conclusions, and it is also contrary to a finding of Consumer Report’s 1995 study which failed to find a relationship between therapist level of training and outcome.
led to many other outcome studies, most of which have supported his findings
This is partly correct, in that many other outcome studies did follow Eysenck’s study; however, most of these have contradicted his findings. Indeed, even Eysenck modified his conclusion in 1985 by indicating that at least one therapy, behavior therapy, is superior to placebo or no treatment.
Additional Information: Eysenck
Traditional psychoanalytic psychotherapy and brief therapies derived from it share several characteristics but also differ in a number of ways. Which of the following is not true about brief forms of psychodynamic psychotherapy?
Select one:
A. In brief psychotherapy, past experiences are important to the degree that they contribute to the client’s current conflicts.
B. Brief therapy targets specific therapeutic goals, which are identified during the first few sessions.
C. In order to solve a client’s problems rapidly, brief therapy makes use of the “transference cure” rather than fostering the client’s insight into his or her problems.
D. Brief therapy can be described as a problem-solving process in which the therapist helps the client use his or her own resources to resolve current difficulties.
Correct Answer is: C
This is the opposite of what is true. In brief forms of psychodynamic psychotherapy, client insight is desirable, although it is limited to those areas that are identified as the targets of therapy.
Brief dynamic therapy is least likely to involve
Select one:
A. a focus on specific problems.
B. an emphasis on restoring the person to a previous level of normal functioning.
C. an attempt to engender insight into the unconscious.
D. the use of techniques such as free association and dream interpretation.
Correct Answer is: B
An emphasis on restoring the person to a previous level of normal functioning sounds more like the goal of crisis intervention than that of brief psychotherapy. Brief dynamic therapy is focused on specific symptoms; whereas, the goal of long-term psychodynamic therapy is usually global personality change. These symptoms are usually viewed as pathological; in other words, the emphasis is on altering the normal level of functioning rather than returning the person to it. Two of the responses (“an attempt to engender insight into the unconscious” and “the use of techniques such as free association and dream interpretation”) describe possible aspects of brief dynamic therapy. Techniques of long-term dynamic therapy, such as free association and dream interpretation, may be used. In addition, there may be an attempt to engender insight into the unconscious, but (unlike as in long-term therapy) the patient is left to assimilate this insight on his or her own.
Additional Information: Brief Psychotherapy
The clinical scales of the MMPI-2 were developed using empirical criterion keying. This means that
Select one:
A. items which distinguish between specific subgroups of people are retained for the final version of the test.
B. items that have high correlations with the previous version of the test are retained for the final version of the test.
C. items that have high correlations with other tests designed to measure similar constructs are retained for the final version of the test.
D. items which appear to measure what they are designed to measure are retained for the final version of the test.
Correct Answer is: A
In empirical criterion keying, items are assessed to determine how well they distinguish between prespecified criterion groups (e.g., between depressed and non-depressed individuals). The items that best distinguish between the groups are maintained for the final version of the scale or the test.
Additional Information: Introduction (MMPI-2)
Someone advocating an emic rather than an etic approach to cross-cultural psychology would argue that the study of a culture
Select one:
A. should be undertaken from a detached and objective position.
B. should be undertaken from within the culture itself.
C. should involve a comparison across different cultures.
D. should use the history of the culture being studied as a reference point.
Feedback
Correct Answer is: B
The emic/etic distinction was first made by an anthropologist named Pike in 1954 and has since been applied to cross-cultural psychology. The etic approach to the study of a culture involves studying it from the outside, using universally accepted means of investigation. The emic approach, by contrast, involves studying the culture from the inside and trying see it as its own members do.
Additional Information: Emic-Etic Distinction
An effective behavioral treatment to reduce the symptoms of depression is Structured Learning Therapy (SLT). SLT contains all of the following except: Select one: A. social skills training B. overcorrection C. modeling D. role-playing
Correct Answer is: B
Structured Learning Therapy incorporates “social skills training,” an early approach to the treatment of depression, along with “modeling,” “role-playing,” skill instruction, and performance appraisal (which make these the incorrect options). (See: A. P. Goldstein, Psychological Skills Training: The Structured Learning Technique, New York, Pergamon Press, 1980.)
Irving Yalom (1985) felt the most important therapeutic factors in groups were:
Select one:
A. Altruism, universality, installation of hope
B. Instillation of hope, catharsis, existential factors,
C. Cohesiveness, altruism, universality
D. Interpersonal learning, catharsis and cohesiveness .
Correct Answer is: D
Yalom felt the most important factors in group process were interpersonal learning, which gave members an opportunity to learn valuable interpersonal skills, catharsis, where group members are able to openly express their feelings in front of other members, and group cohesiveness where group members feel a sense of cohesiveness and friendliness with other group members. However the importance of these factors is relative. Higher functioning group participants rate interpersonal learning and universality as more important. In lower functioning clients the instillation of hope is deemed most important.
Additional Information: Therapeutic Factors of Group Therapy
The final stage in Atkinson, Morten, and Sue’s Minority Identity Development Model is characterized by:
Select one:
A. identification with the majority group and dis-identification with the minority group
B. identification with the minority group and dis-identification with the majority group
C. disillusionment with both the minority group and the majority group
D. biculturalism or multiculturalism
Correct Answer is: D
In the final stage of the Minority Identity Development Model (which was later renamed the Racial/Cultural Identity Development Model) “the person becomes bicultural or multicultural without a sense of having sold out his/her integrity” [D. W. Sue and D. Sue, Counseling the culturally different: Theory and practice, 3rd edition,1999, New York, John Wiley, p. 136].
Additional Information: Minority Identity Development Model
The most correct statement that can be made about biofeedback as a therapeutic treatment for pain reduction is that
Select one:
A. the significant effects found can be accounted for by the type of instrumentation employed.
B. it is effective for certain types of patients only.
C. its effectiveness has diminished over the years.
D. it is probably no different from relaxation training in its effectiveness.
Correct Answer is: D
Research on the efficacy of biofeedback for pain reduction indicates that it is as effective as treatments such as relaxation training. This is true for the treatment of most disorders or conditions, however in cases such as the treatment of Raynaud’s Disease or migraine headaches, some studies suggest that biofeedback is the treatment of choice.
Additional Information: Biofeedback
The Treatment of Depression Collaborative Research Program (TDCRP), conducted by the National Institute of Mental Health, compared Cognitive Therapy, antidepressant medication, pill placebo, and interpersonal psychotherapy treatments in depressed outpatients. The results of this study found:
Select one:
A. cognitive therapy is more effective than the other treatments for mild to moderate depression
B. cognitive therapy is more effective than the other treatments for moderate to severe depression
C. no difference in observed outcome between cognitive therapy and antidepressant medications (ADMs) for mild to moderate depression.
D. no difference in observed outcome between cognitive therapy and antidepressant medications (ADMs) for moderate to severe depression.
Correct Answer is: C
Findings of the NIMH’s TDCRP research project indicate no differences in outcome were observed between CT and ADM among all patients. In other words, overall, cognitive therapy (CT) and antidepressant medication are about equally effective in the treatment of depression. In a secondary analysis of more severely depressed patients, however, ADM outcomes were superior to both cognitive therapy and placebo. Antidepressant medications (ADMs) are the most widely used treatment for major depressive disorder (MDD) in the United States and evidence supports the efficacy of ADMs, particularly among more severely depressed patients, as first-line therapy for patients with moderate to severe MDD. (See: DeRubeis, R.J., Hollon, S.D., Amsterdam, J.D., Shelton, R.C., Young, P.R., Salomon, R.M., O’Reardon, J.P., Lovett, M.L., Gladis, M.M., Brown, L.L., & Gallop,R. (2005) Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression. Archives of General Psychiatry.62(4):409-416.)
Self-in-Relation theory suggests that:
Select one:
A. the self progresses from infantile dependence to mature independence
B. one’s self depends on how one connects to others
C. people prefer to be right rather than happy
D. the relationships between siblings is the most important influence in the development of the self
Correct Answer is: B
Self-in-Relation theory is a feminist theory which emphasizes the importance of one’s connections with others, particularly a daughter’s relationship with her mother. The development of the self is viewed as progressing from infantile dependence towards a mature state of interdependence.
the self progresses from infantile dependence to mature independence
This is in contrast to the traditional Western view of human development – a progression from infantile dependence towards a state of greater and greater separation, individuation, and independence.
people prefer to be right rather than happy
This refers to Self Verification theory which proposes that people need and seek confirmation of their self-concept, regardless of whether their self-concept is positive or negative.
Additional Information: Self-in-Relation Theory
An African-American client refuses to work with a non African-American therapist under any circumstances. From the perspective of Atkinson, Morten, and Sue’s Minority Identity Development Model,
Select one:
A. the client’s reaction is typical and expected due to lifelong experiences of racism.
B. the client’s reaction reflects a failure of racial identity development.
C. the client may be in the dissonance stage of identity development.
D. the client may be in the resistance and immersion phase of identity development.
Correct Answer is: D
Atkinson, Morten, and Sue’s Minority Identity Development Model is based on the notion that the phases of development are rooted in the struggle to form a strong sense of self- and group identity in the face of oppressive conditions. They identified five phases of cultural identity development that blend into each other, without clear boundaries: 1) conformity, in which individuals reject the values of their own racial group and strive to assimilate into the dominant culture; 2) dissonance, a transition phase where positive attitudes towards the dominant culture and negative attitudes toward one’s own group are examined and questioned; 3) resistance and immersion, which involves unconditional acceptance of one’s own racial group and complete rejection of the dominant culture; 4) introspection, where the person questions the monolithic viewpoints of the previous stage, is able to see positive as well as negative aspects of the dominant culture, and focuses more on individual identity issues; and 5) synergistic articulation and awareness, which is characterized by a secure balance between personal and racial identity, the desire to eliminate all forms of oppression as opposed to just oppression aimed at one’s own group, and appreciation of positive aspects of the dominant culture. From the perspective of this theory, the resistance and immersion phase of development would most likely include rejecting any possibility of working with a therapist of a different racial group. It is true that such a refusal could be due to lifelong experiences of racism, as stated by the choice “the client’s reaction is typical and expected due to lifelong experiences of racism.” However, because you are asked to answer from the perspective of the Minority Identity Development Model, the correct answer is a better option.
Additional Information: Minority Identity Development Model
The use of the technique known as self-instruction with hyperactive children involves
Select one:
A. programmed learning.
B. having the children write down their daily goals in advance.
C. having the children make self-statements.
D. having the children do the their schoolwork by themselves.
Correct Answer is: C
Donald Meichenbaum developed the technique of self-instruction as a means of helping impulsive and hyperactive children to perform tasks more successfully. The technique involves teaching the subject to make appropriate self-statements while performing a desired task.
Additional Information: Self-Instructional Training
According to the theory of psychopathology on which Beck’s model of cognitive therapy is based, which of the following is true regarding the role of schema?
Select one:
A. Dysfunctional schemas always cause problems, even if they are not associated with symptomatic behavior.
B. Certain types of schema, known as “core schema” are not accessible to the conscious mind.
C. Schemas govern cognition but not other psychological phenomena such as memory, affect, or motivation.
D. Dysfunctional schema develop over the course of life experience beginning in childhood.
Correct Answer is: D
According to Beck, schemas are relatively stable cognitive patterns on which attention to and interpretations of external events are based. In a depressed individual, the person’s interpretation of external events is distorted to fit the schema. For example, a person who views him- or herself as worthless and deserving rejection will tend to interpret the statements and behaviors of others as rejection. Beck believed that life experiences, beginning in childhood, provide the basis for forming schemas. As an example, the belief that all losses are irreversible is a core schema that may have been formed due in large part to the death of a parent in childhood.
Let’s briefly go through the other choices.
Dysfunctional schemas always cause problems, even if they are not associated with symptomatic behavior.
This choice is incorrect because not all schemas – even dysfunctional schemas – cause problems. This is because, according to Beck, some schemas are inactive and remain so unless they are activated by external events.
Certain types of schema, known as “core schema” are not accessible to the conscious mind.
This is wrong because Beck believed that schemas – including core schemas, or basic assumptions about oneself and the world – are readily available to the patient’s conscious mind; this is one way that he distinguishes the cognitive therapy approach from psychoanalysis.
Schemas govern cognition but not other psychological phenomena such as memory, affect, or motivation.
This is wrong because Beck believed that schemas are involved in memory, affect, and motivation, as well as all other functions related to perception and information processing.
Additional Information: Schemas (Beck)
Of the following ethnic groups which group is not considered a race? Select one: A. Hispanic B. Native American C. African-American D. Asian-American
Correct Answer is: A
Hispanics are an ethnic group like African-Americans, Asian-Americans, and Native Americans. Unlike these groups, Hispanics are not a specific race. According to the 1998 Census Bureau, the total Hispanic population of the US accounts for 11% of the total population. Sixty-three percent are of Mexican origin, 14.4% are of Central and South American origin, 10.6% of mainland Puerto Rican origin, 4.2% of Cuban origin, and 7.4% other (Alfredo Ardilis, Testing Hispanic Populations, Texas Psychologist, Winter 2000).
Additional Information: Counseling Hispanic Clients
A person's negative attitudes toward an individual because of his or her sexual orientation is referred to by Gregory Herek (2000) as: Select one: A. sexual prejudice B. homophobia C. homosexism D. gay inequality
Correct Answer is: A
Gregory Herek, an authority on prejudice against lesbians and gay men, suggests the use of the term “sexual prejudice” to refer to all negative attitudes based on sexual orientation, whether the target is homosexual, bisexual, or heterosexual. Herek suggests that “sexual prejudice” is a more appropriate term than “homophobia” - which refers to heterosexuals’ dread of being in close quarters with homosexuals and homosexuals’ self-loathing.
Additional Information: Sexual Prejudice
Jungian theory differs from Freudian theory in that
Select one:
A. Jung had a more optimistic outlook on the ability of psychoanalysis to effect a cure.
B. Jung endorsed the notion of psychic determinism.
C. Jung focused on the “here-and-now”; Freud focused on the past.
D. Jung had a different theory about the role of the unconscious than Freud.
Correct Answer is: D
Among other things, Jung and Freud disagreed about the nature of the unconscious. For Freud, the unconscious is primarily the product of the individual’s personal history – it contains innate drives as well as material (e.g., fantasies, memories, affects) accumulated over the life span. For Jung, the unconscious consists of both a personal and collective component. The collective unconscious contains latent memories of our cultural past, archetypes (innate ideas that ready us for human experience), and even prehuman memories.
Additional Information: Carl Jung’s Analytical Psychology
A young child starts to act out while waiting for the food to be served at a restaurant. According to systems theory, in order to the restore the family to its previous state of equilibrium, the parent will:
Select one:
A. use negative feedback to restore homeostasis
B. use negative feedback to unbalance the system further and bring the child back into line
C. use positive feedback to restore homeostasis
D. use positive feedback to correct the child’s behavior
Correct Answer is: A
In systems theory, feedback refers to information from within the system which results in changes in either the existing homeostasis or the maintenance or restoration of homeostasis. Positive feedback alters the system to accommodate novel input or a new state of equilibrium and negative feedback maintains or restores the status quo of the system. If a child misbehaves while the family is at a restaurant, negative feedback occurs when the parent corrects the misbehaving and restores homeostasis.
A client presents as cool, calm, and collected, but has an underlying rage and by the end of the session, the therapist feels angry. This is an example of:
Select one: A. parallel process. B. projective identification. C. introjection. D. diagnostic overshadowing.
Correct Answer is: B
Projective identification is a defense mechanism in which one or more parts of the self are falsely attributed to another, which are then unconsciously accepted by the recipient, and the projector then identifies with the projected part in the other.
Recreating the supervisee-client relationship in the supervisee-supervisor relationship through a combination of transference, countertransference, and projection is referred to as parallel process. Introjection involves absorbing the values or behaviors of others, including the larger society, without really understanding or assimilating those values or behaviors. Introjection represents a disturbance in the boundary between self and others - the person does or believes things that are not reflective of a self that is clearly distinct from others in the environment. Diagnostic overshadowing* refers to the tendency to attribute all of a client’s emotional, behavioral, and social problems to one salient characteristic instead of considering other, alternative explanations (* incorrect choices).
Lazarus cognitive appraisal theory suggests the emotional reaction to a situation follows a cognitive assessment of the situation and identifies three types of appraisal:
Select one:
A. central appraisal, peripheral appraisal and re-appraisal.
B. conscious, unconscious and semiconscious appraisal.
C. phonemic, structural and semantic appraisal.
D. primary appraisal, secondary appraisal and re-appraisal.
Correct Answer is: D
Lazarus cognitive appraisal theory suggests the emotional reaction to a situation follows a cognitive assessment of the situation. His theory differentiates between three types of appraisal: primary, which refers to one’s perception of the situation (i.e., positive, negative, or irrelevant); Secondary, which refers the assessment of resources available to deal with the situation; and re-appraisal, referring to watching the situation and changing the other types of appraisals as necessary.
Structural, phonemic, and semantic are from the levels of processing theory of memory.
An individual’s symptoms of tension headaches, nausea, hyperventilation and heart palpitations would be most likely to be interpreted by a client-centered therapist as relating to:
Select one:
A. overwhelming environmental stress
B. being unable to fulfill one’s own needs
C. unresolved intrapsychic conflicts
D. denied threats to the self-concept
Correct Answer is: D
According to client-centered therapy, when an individual’s natural tendency toward growth and actualization is disrupted by incongruence between the self and experience (e.g., others’ evaluations differing from one’s self-concept), personality and behavioral problems arise. Denying or distorting the experience is one way of dealing with the incongruence. According to Rogers, denial and distortion leads to anxiety which may result in visceral symptoms such as those listed in the question.
Additional Information: Theory of Personality and Pathology and Goals of Therapy (Client-Centered Therapy)
A genogram would be used by a Bowenian therapist to:
Select one:
A. identify genetic (biological) contributions to maladaptive behavior.
B. examine family relationships over several generations.
C. evaluate the progress and outcome of therapy.
D. examine interactions between a family and its environment.
Correct Answer is: B
A genogram, as Bowen described, is a schematic diagram of the family’s relationships used to identify behavior patterns that recur in the family and usually includes at least three generations. The term ecomap (“examine interactions between a family and its environment”) is sometimes used interchangeably with genogram; however the question notes the use of a genogram by a Bowenian therapist, so “examine family relationships over several generations” is the best answer.
Additional Information: Goals and Techniques of Therapy (Extended Family Systems Therapy)
Asian-American students often outperform their non-Asian peers on various measures of academic achievement. Research suggests that the best predictor of higher achievement in Asian-Americans is: Select one: A. estimate of ability. B. fear of academic failure. C. self-efficacy beliefs. D. effort beliefs.
Correct Answer is: B
Asian-American and non-Asian students not only differ in terms of achievement but also in their attributions for academic success. Asian-Americans are more likely to cite fear of failure as the main contributor to academic success, while non-Asians are more likely to attribute successful performance to effort.
Additional Information: Counseling Asian-American Clients
An African-American client who is referred to an African-American therapist states that he has been cheated because he is getting sub-standard care. According to the minority identity development model, this person is in which stage of development? Select one: A. conformity B. dissonance C. resistance D. introspection
Correct Answer is: A
The Minority Identity Development (MID) model defines five stages of identity development in African-Americans and other minority groups who share an experience of oppression. The stages are Conformity, Dissonance, Resistance and Immersion, Introspection, and Synergistic Articulation and Awareness. In the first stage, Conformity, the person is likely to have strong negative feelings toward one’s own culture and strong positive feelings toward the dominant culture. Thus, an African-American who feels cheated by having to see an African-American therapist would likely be in the Conformity stage of development.
Additional Information: Minority Identity Development Model
A therapist typically conceptualizes cases from a psychodynamic theoretical framework and uses related techniques however, she uses an empty chair technique in a therapy session. The therapist's use of this technique is consistent with: Select one: A. theoretical integration. B. assimilative integration. C. technical eclecticism. D. common factors.
Correct Answer is: B
An openness to various ways of integrating diverse theories and techniques characterizes psychotherapy integration. What differentiates psychotherapy integration from an eclectic approach is that in an eclectic approach, a therapist chooses interventions based on what works without considering a theoretical basis for using the technique, while psychotherapy integration attends to the relationship between technique and theory. Assimilative Integration is an approach to psychotherapy integration in which the therapist has a commitment to one theoretical approach but also is willing to use techniques from other therapeutic approaches.
Additional Information: Psychotherapy Integration
A primary tenet of rational-emotive therapy is that:
Select one:
A. a belief determines behavior.
B. self-attributions determine behavior.
C. conditioning determines behavior.
D. internalized role constructs determine behavior.
Correct Answer is: A
RET is basically a cognitively-based theory even though in practice therapists use many modalities. The idea is that beliefs – irrational beliefs – determine our maladaptive behaviors. The belief that you mustn’t make anyone mad at you is an example.
Additional Information: Rational Emotive Behavior Therapy (REBT)
A student seeks counseling at the university counseling center due to feelings of failure as a student. When asked about his grades, he states that his grade point average is 3.9 but thinks that he should be doing better. He is most likely using which of the following cognitive distortions? Select one: A. arbitrary inference B. overgeneralization C. personalization D. dichotomous thinking
Correct Answer is: A
Arbitrary inference occurs when one draws a specific conclusion without supporting evidence, or even in the face of contradictory evidence. This best applies to the student in this question. Despite having a nearly perfect GPA, the student believes he’s a failure and should be doing better. Overgeneralization is the application of a general rule based on a few isolated incidents. Personalization is attributing external events to oneself without evidence of a causal connection. And dichotomous thinking is categorizing experiences into one of two extremes.
Additional Information: Cognitive Distortions (Beck)
According to Marlatt and Gordon, which of the following most increases the chance of relapse in a substance abuser?
Select one:
A. life changes
B. negative affects
C. physiological cravings
D. decreased treatment durations due to the limits set by managed care companies
Correct Answer is: B
Marlatt and Gordon are best known for their Relapse Prevention Therapy which views substance dependence as a collection of maladaptive over-learned habits. According to their research, nearly 75% of all relapses are due to negative affects, interpersonal conflict, and social pressure.
Additional Information: Relapse Prevention Therapy (Marlatt & Gordon)
According to Prochaska and DiClemente's Stages of Change Model, which stage best applies to a man who is aware of his drinking problem, recognizes the benefits of getting sober, and plans to quit drinking on his birthday in three months? Select one: A. Minimization B. Precontemplation C. Contemplation D. Preparation
Correct Answer is: C
Prochaska and DiClemente described five Stages of Change in their model - which applies to many types of behaviors - not just substance abuse. The first stage is “Precontemplation,” characterized by denial, resistance, and no plans to change. In the second stage, “Contemplation,” a person begins to recognize the benefits of change and, although somewhat ambivalent, plans to change within the next 6 months. This best describes the person in this question. In the third stage, “Preparation,” a person has decided to take action within the next 30 days and may have already begun to take small steps towards change. In the next stage, “Action,” the person is actively engaged in making changes or acquiring new behaviors. The final stage is the “Maintenance” stage, in which the person has maintained action for at least 6 months and is actively working to prevent a relapse.
Additional Information: Transtheoretical Model of Change
Depressogenic schemata such as arbitrary inference and selective abstraction are associated with: Select one: A. Lewinsohn B. Beck C. Seligman D. Ellis
Correct Answer is: B
Depressogenic schemata, or cognitive distortions, such as overgeneralization, personalization, magnification, arbitrary inference, and selective abstraction are reflected statements in Beck’s “depressive cognitive triad.” “Lewinsohn” is associated with the findings that depressed individuals’ self-evaluations reflect an unbiased perception of reality and more accurately correspond with observer evaluations, “Seligman” is associated with the theory of learned helplessness, and “Ellis” with Reactive Emotive Therapy (RET).
Additional Information: Cognitive Distortions (Beck)
A business executive parent and artistic adolescent child come to a solution-focused family therapist for help dealing with conflicts in their relationship. Which of the following techniques are most likely to be used?
Select one:
A. Miracle and scaling questions
B. Joining and restructuring
C. Non-directive listening and interpretation
D. Paradoxical directives and reframing
Correct Answer is: A
Solution-focused therapists use a variety of techniques designed to identify solutions to client’s problems. Two such techniques are the miracle and scaling questions. The miracle question invites the client to imagine what it would be like if his/her problem was suddenly gone. The scaling question invites each family member to rate a situation to see how the problem is perceived by others.
Joining and restructuring
Joining and restructuring are used by structural family therapists.
Non-directive listening and interpretation
Non-directive listening and interpretation are used by object relations family therapists.
Paradoxical directives and reframing
Paradoxical directives and reframing are used by strategic family therapists.
In terms of worldview, Sue and Sue (1990) propose that minority groups are increasingly more likely to exhibit an
Select one:
A. external locus of control and responsibility.
B. internal locus of control and responsibility.
C. external locus of control, internal locus of responsibility.
D. internal locus of control, external locus of responsibility.
Correct Answer is: D
Sue and Sue (Counseling the Culturally Different, New York, John Wiley, 1990) indicate that minority group members are becoming increasingly aware of their own ethnic identity and adopting a worldview that reflects an internal locus of control and an external locus of responsibility.
external locus of control and responsibility.
An external locus of control and responsibility is more characteristic of a “placater” who adopts a passive role.
internal locus of control and responsibility.
Internal locus of control and responsibility is characteristic of the Westernized approach to counseling and white middle-class clients.
external locus of control, internal locus of responsibility.
An external locus of control and internal locus of responsibility is more characteristic of “marginalized” individuals who have been oppressed by the dominant group.
Additional Information: Worldview
According to Beck, depression is caused by Select one: A. biochemical factors. B. early parental rejection. C. dysfunctional automatic thoughts. D. dysfunctional irrational thoughts.
Feedback
Correct Answer is: C
The purpose of Beck’s cognitive therapy is to modify dysfunctional automatic thoughts that are seen as the cause of maladaptive emotional responding (e.g., depression and anxiety). Unlike Ellis, who identifies irrational thoughts as the cause of clients’ problems, Beck believes that these thoughts may or may not be irrational.
Additional Information: Depression (Beck)
The term "collaborative empiricism" is associated with: Select one: A. Aaron Beck B. Albert Ellis C. Fritz Perls D. Donald Meichenbaum
Correct Answer is: A
In Beck’s cognitive-behavioral therapy “collaborative empiricism” refers to the collaborative relationship between client and therapist using a rational, logical approach to examine the client’s thoughts and assumptions - which are treated as hypotheses to be tested.
Additional Information: Introduction (Beck’s Cognitive Therapy)
Which of the following is not an advantage of the use of co-therapists in group therapy, according to Yalom?
Select one:
A. The observational range of co-therapists is greater than that of a single group leader.
B. Co-therapists broaden the range of possible transferential reactions, making the nature of the client’s transferential distortions more evident.
C. A co-therapist can provide a beginning group therapist with needed objectivity and expertise.
D. When co-therapists pursue their own separate agendas in therapy, clients have the opportunity to intervene and learn conflict management skills.
Correct Answer is: D
According to Yalom, a potential disadvantage of the co-therapy format is that co-therapists may be overly competitive and pursue their own interpretations rather than supporting inquiries begun by the group. If this occurs, the group will be distracted and unsettled. The other choices describe potential advantages of the use of co-therapists.
Additional Information: Co-Therapists (Group Therapy)
Johnny, age 10, teaches his brother Justin, age 5, how to ride a skateboard. This interaction can best be described as: Select one: A. Parallel process B. Complementary communication C. Elaborative rehearsal D. Symmetrical communication
Correct Answer is: B
Communication patterns can be characterized as either symmetrical or complementary. In symmetrical communication there is equality between the partners. In complementary communication there is inequality, with one member taking a dominant role and the other a subordinate role. In this example, Johnny, the older brother, took on the dominant teacher role and his younger brother was in the subordinate role of student. Although completely unrelated to this model, you should also be familiar with the other two terms – parallel process and elaborative rehearsal. Parallel process is a phenomenon in clinical supervision where the therapist in training behaves toward the supervising therapist in ways that mirror how the client is behaving toward the therapist in training. Elaborative rehearsal involves thinking about how new information relates to existing memory.
Additional Information: Complementary Communications
The effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in the treatment of Posttraumatic Stress Disorder is due to:
Select one:
A. exposure to anxiety-provoking stimuli
B. changes in the functioning of the brain due to lateral eye movement stimulation
C. unconditional positive regard
D. placebo effect
Correct Answer is: A
Eye Movement Desensitization and Reprocessing (EMDR) is a controversial therapeutic technique which combines techniques from cognitive-behavioral and other treatment approaches with lateral eye movements. Clients receiving EMDR are asked to recall anxiety-provoking memories and are then instructed to track the therapists fingers which are moved from side to side. This process is repeated until the clients anxiety is extinguished. Although Francine Shapiro, the developer of the technique, originally proposed that the bilateral eye movements accelerate the reprocessing of traumatic memories, a meta-analysis of 34 studies indicated that the eye movement component did not contribute to the effectiveness of EMDR. Rather, it appears that the element of exposure is responsible for its effects. The meta-analysis did find EMDR to be more effective than no-treatment or non-exposure treatments; however, it was no more effective than other exposure techniques. (P. R. Davidson, & K. C. Parker, Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Psychology-Clinical Psychology, 2001, 69(2), 305-316).
Additional Information: Eye Movement Desensitization and Reprocessing (EMDR)
Which of the following is likely to be most effective for alleviating chronic pain?
Select one:
A. biofeedback
B. hypnotherapy
C. relaxation and coping skills training
D. autogenic training and contingency management
Correct Answer is: C
Most experts advocate a comprehensive treatment approach for chronic pain. Their recommended treatments involve teaching the patient a number of coping skills designed to alleviate pain and improve the patient’s feelings of control. See, for example, H. Philips, The effects of behavioral treatment on chronic pain, Behaviour Research and Therapy, 1987, 25, 365-377.
When working with African-American families, Nancy Boyd-Franklin recommends: Select one: A. An ecostructural approach B. A multisystems approach C. A matrilineal approach D. Both a and b
Correct Answer is: D
Boyd-Franklin (1989) recommends the use of a multisystems (ecostructural) approach when working with African-American families. During both the assessment and treatment processes this approach targets the individual, the immediate and extended family, nonblood relations and friends, church and other community services.
Additional Information: Counseling African-American Clients
In writing about the relationship between therapist/client ethnic match and therapy outcome, Stanley Sue has noted that “ethnicity of therapist or client and ethnic match are distal variables.” By distal variable, he means one which
Select one:
A. may contribute to but does not directly impact therapy outcome.
B. is one of many variables that directly impact therapy outcome.
C. is the major factor in influencing therapy outcome.
D. is completely unrelated to therapy outcome.
Correct Answer is: A
The dictionary definition of distal is the more distant of two things. In research and theory, a distal variable is an indirect factor that is less temporally close to other variables and indirectly contributes to but does not directly impact outcome. Distal variables are often global, stable, and trait-like factors, such as demographic variables, family characteristics, and personality traits. For example, Sue wrote that “Ethnicity of therapist or client and ethnic match are distal variables…Ethnicity per se tells us very little about the…behavior of individuals, therapists or clients, who interact in a therapy session”. Distal variables are usually contrasted with proximal variables. Proximal means nearest, and a proximal variable is a process or detail aspect of the environment that directly impacts and occurs relatively shortly before outcome. Proximal variables can usually be manipulated or changed. In reference to the quote in the question, the behaviors of therapists and clients would most likely exemplify proximal variables.
Additional Information: Therapist-Client Similarity
Traditional Western approaches to individual psychotherapy can best be described as: Select one: A. linear and reductionist B. non-linear and holistic C. relativistic and abstract D. elitist and futile
Correct Answer is: A
Traditional Western approaches to individual psychotherapy emphasize linear causal relationships and are reductionistic, that is, they tend to explain complex phenomena in terms of relatively simple principles. Non-linear, holistic, and relativistic are terms used to describe non-western and systems approaches.
Additional Information: Cultural Encapsulation
Howard et al.'s (1993) phase model of psychotherapy change does NOT include: Select one: A. remoralization B. reexamination C. remediation D. rehabilition
Correct Answer is: B
The phase model of psychotherapy, an extension of the dose-response model of treatment response, was first proposed by Howard et al. in 1993 and is a client stage model that outlines a progressive, 3-stage sequence of change. The first phase, remoralization, focuses on the client’s subjective well-being and occurs during the first few sessions. The second phase, remediation, focuses on symptom reduction and generally occurs between the 5th and 15th sessions. The third and final phase is rehabilitation which focuses on life functioning gains and emerges more gradually. According to this model, effective courses of treatment are initially characterized by a restored subjective sense of well-being then, as a function of this improvement, the client may benefit from interventions to provide symptom reduction or relief (e.g., decrease difficulty concentrating or sleep disruption) and finally, is able to either resume their former level of role functioning (e.g., doing well at work) or initiate new roles (e.g., obtaining a new job). (See: Howard, K. I., Lueger, R. J., Maling, M. S., & Martinovich, Z. (1993). A phase model of psychotherapy outcome: Causal mediation of change. Journal of Consulting and Psychology-Clinical Psychology, 61, 678-685. and K. Howard et al., Evaluation of psychotherapy: Efficacy, effectiveness, and patient progress, American Psychologist, 51, 1059-1064, 1996.)
BASIC ID is utilized by which of the following to assess what interventions will work for a particular client?
Select one:
A. Rational emotive therapy
B. Multimodal therapy
C. Eye movement desensitization and reprocessing
D. Cognitive behavioral modification
Correct Answer is: B
BASIC ID is an acronym that represents the seven areas of the client’s life that are examined in Lazarus’s multimodal therapy: behavior, affective responses, sensations, images, cognitions, interpersonal relationships, drugs, biological functions, nutrition and exercise.
Rational emotive therapy (RET) is a form of cognitive-behavioral therapy (CBT) in which the primary focus proposes changes in thinking will lead to changes in behavior, thereby alleviating or improving symptoms. The emphasis is on changing irrational thinking patterns that cause emotional distress into thoughts that are more reasonable and rational. Eye movement desensitization and reprocessing (EMDR) is therapeutic technique which combines techniques from cognitive-behavioral and other treatment approaches with lateral eye movements. Clients receiving EMDR are asked to recall anxiety-provoking memories and are then instructed to track the therapists’ fingers which are moved from side to side. This process is repeated until the clients’ anxiety is extinguished.
A therapist seeing a family consisting of a couple and their son asks the father to describe the relationship between the mother and her son. The therapist is using which of the following techniques? Select one: A. circular questioning B. embedded suggestion C. joining the family D. process interruption
Correct Answer is: A
Circular questioning involves asking questions that highlight differences among family members or define relationships between them. Usually, it will involve asking a family member about the perceptions of the relationship between other family members, as in this question. The technique is designed to provide information about family processes to the therapist and other family members, to get family members to see problems from different perspectives, to lead to further exploration, and to form the basis for further circular questioning. It is particularly associated with the Milan Systemic School of family therapy.
Additional Information: Goals and Techniques of Therapy (Strategic Family Therapy)
Cognitive behavior therapy, compared to operant behavior treatments, has been found to be:
Select one:
A. less effective across most diagnostic categories.
B. superior with more intelligent clients.
C. approximately equally effective with all types of disorders.
D. more effective with addictive disorders.
Correct Answer is: C
The question is about the research showing that all types of treatments are about equal with all types of disorders. Outside of Agoraphobia, Specific Phobias (including school phobia), and sometimes some physiological problems, such as enuresis, psychological treatments tend to be about equal in their efficacy.
Additional Information: Evaluation of Cognitive Therapy
In Gestalt therapy, introjection, projection, deflection, confluence and retroflection are examples of: Select one: A. layers of neurosis B. resistances to contact C. natural anxiety D. neurotic anxiety
Correct Answer is: B
Gestalt therapy focuses on the “here and now” which encourages clients to gain awareness and full experiencing in the present. The term contact refers to interacting with nature and others without losing one’s individuality. Resistances to contact are the defenses that one develops as a self-protective attempt to avoid the anxiety necessitated by change and prevents full experiencing in the present. The question lists the five defenses or types of resistance to contact.
The five layers of neurosis, proposed by Perls (1969) to describe the process of working through neurosis are: phony, phobic, impasse, implosive, and explosive. Neurotic anxiety is the result of not facing normal anxiety.
Additional Information: Theory of Personality (Gestalt Therapy)
Wolfgang Kohler, a founder of the gestalt school of learning and thought, is known for applying gestalt learning principles to the development of
Select one:
A. unfinished business.
B. insight.
C. integration of all parts of the psyche.
D. awareness of psychological boundaries.
Correct Answer is: B
Kohler, a founder of the gestalt school of psychology, studied insight learning. In one of his experiments, a chimpanzee had to get some food placed outside his cage. He had two sticks but they were too short to reach the food. As he was sitting with the two sticks in his hand, the chimp had what Kohler called an “a-ha experience”: He quickly fit the sticks together and was able to get the food. This a-ha experience – a sudden, novel solution to the problem – is the basis of insight learning. According to Kohler, insight learning cannot be explained by traditional behavioral theories of learning, which are based on reinforcement and associations between stimuli.
Additional Information: Gestalt Learning Theory
Research by Sue and his colleagues (1991) suggests that which of the following clients is most likely to return for a second session of psychotherapy? Select one: A. an African-American client B. a Latino-American client C. an Anglo-American client D. an Asian-American client
Correct Answer is: D
Studies on therapy dropout rates have produced inconsistent results. This question is asking about a particular study, however (Sue et al., 1991), which found that African-Americans have the highest dropout rates, while Asian-Americans have the lowest dropout rates.
Additional Information: Utilization of Mental Health Services by Minority Group Members
Which of the following is not an aspect of crisis theory?
Select one:
A. overwhelming emotions are the prime motivators for change
B. crisis theory emphasizes the cognitive and behavioral elements of a crisis
C. people in crisis tend to follow a predictable sequence of responses
D. crisis intervention will be more successful when a client is able to understand how his or her behavior is related to the crisis
Correct Answer is: A
According to crisis theory, people in crisis tend to follow a predictable sequence of responses* and a key goal of crisis intervention is to help individuals in crisis learn more effective coping so that they can respond more adaptively when having similar experiences in the future. Crisis management strategies often include grief work; active listening; encouraging the open expression of feelings; increasing understanding of the crisis; promoting greater acceptance of reality; exploring constructive ways of coping; linkage to a social network; decision counseling; and reinforcement of newly learned coping behaviors. While addressing a client’s emotions, including overwhelming ones, is a part of crisis intervention, crisis theory and crisis intervention also emphasize the cognitive and behavioral elements of a crisis. Although crisis theorists do predict that crisis intervention will be more successful when a client is able to understand the crisis situation (e.g., how his or her behavior is related to the crisis), neither insight nor the resolution of internal conflicts is considered a prerequisite for change or problem-solving during crisis intervention (* These are correct statements which makes them incorrect options).
Additional Information: Goals and Characteristics of Crisis Intervention
IPT believes that depression is primarily caused by:
Select one:
A. Disturbances in early life especially related to attachment
B. Biochemical factors
C. Disturbances in cognitive functioning
D. Faulty cognitions
Correct Answer is: A
Interpersonal therapy, described by Klerman and Weisman (Klerman G..L., Rounsanville B.. Chevron E., and Weissman M., 1984 Interpersonal Psychotherapy of Depression. New York: Basic Books) relates depression to difficulties with social roles and interpersonal relationships. These are traceable to a lack of strong attachments early in life. The primary goals of IPT are symptom reduction and improved interpersonal functioning.
Additional Information: Interpersonal Psychotherapy
In working with a triangulated family, a structural family therapist would
Select one:
A. work with the most differentiated family members in order to reduce their emotional reactivity.
B. use a paradoxical intervention by taking steps to increase the family’s initial level of triangulation.
C. train the family in communication skills and techniques.
D. upset the family’s balance by blocking the family from its normal interactional pattern.
Correct Answer is: D
Minuchin, the founder of structural family therapy, defines triangulation as a family boundary problem in which each parent demands that the child side with him or her against the other parent. According to Minuchin, the therapist’s goal in this and other situations in which parents attempt to deflect conflict onto children is to restructure the parent-child and spousal subsystems so they function correctly. This involves introducing some stress into the family system to upset the family’s balance and block the family from its normal way of interacting. For example, Minuchin describes strategies such as prohibiting children from talking about symptomatic behavior with their parents, rewarding parents for their capacity to nurture and support each other, and restructuring the parents in a coalition against their child.
Additional Information: Goals and Techniques of Therapy (Structural Family Therapy)
A therapist working from the perspective of Beck’s cognitive therapy would approach the treatment of Panic Disorder by
Select one:
A. having the client identify maladaptive thoughts that precede panic attacks and then restructuring those thoughts.
B. connecting the panic attacks to the client’s overall attributional styles.
C. teaching the client methods of self-reinforcement to use when he or she is not having a panic attack and methods of self-punishment to use when he or she is having one.
D. identifying and modifying the client’s interpretation of panic attacks and their associated physical symptoms.
Correct Answer is: D
Cognitive therapists believe that Panic Disorder is connected to “catastrophic misinterpretations” of bodily sensations, symptoms, and mentation. The client’s “overcastrophization” of early signs of the attack such as hyperventilation results in a full-blown attack. Thus, at least initially, therapy focuses on identifying and modifying the client’s misinterpretations of symptoms and thoughts immediately before and during the attack.
Which of the following types of therapists would be most interested in interpreting the defenses against anxiety that underlie a individual's current maladaptive behavior patterns? Select one: A. reality therapy B. solution-focused therapy C. personal construct therapy D. object relations therapy
Correct Answer is: D
Object relations therapy, a psychodynamic therapy, centers on how unconscious processes impact present relationships by identifying and interpreting defenses and transferences.
reality therapy
Glasser’s reality therapy focuses on current issues and current problems.
solution-focused therapy
Solution focused adopts a here-and-now orientation and focuses on identifying solutions to problems.
personal construct therapy
Kelly’s personal construct therapy combines cognitive, behavioral, and humanistic concepts and focuses on the impact of the individual’s perspective on his/her experience of the world.
According to Janet Helms' (1995) White Racial Identity Development Model, the final stage of racial identity development is: Select one: A. autonomy B. disintegration C. reintegration D. immersion-emersion
Correct Answer is: A
According to Helms, autonomy is the final stage of racial identity development. Autonomy is characterized by a nonracist White identity based on a realistic understanding of the strengths and weaknesses of White culture. At this stage, Whites value and seek out cross-racial interactions.
Additional Information: Helms’ Racial Identity Models
“According to current research, the Rorschach has very low validity.” This statement is
Select one:
A. true.
B. true, except for children between ages 5-10.
C. true, except for its use with a nonverbal population.
D. false.
Correct Answer is: D
The Rorschach, while having a reputation for low validity due to its clinical origins, has increased in validity since the development of John Exner’s scoring system. Hiller, Bornstein, Rosenthal, Berry and Brunell-Neuleib report in Psychological Assessment (September, 1999) that since earlier critiques, two recent developments have given the Rorschach a more favorable outlook. First is the development of Exner’s Comprehensive System for the Rorschach (Exner, 1974; 1978) which systematized scoring procedures for the Rorschach, and reported findings from a large archive of Rorschach protocols of normal adults, as well as from various psychiatric groups. Second, two meta-analyses were published, both comparing criterion-related validity evidence for the Rorschach to that of its chief rival, the MMPI (Atkinson, 1986; Parker, Hanson, and Hemsley, 1989). These studies conclude that validity is roughly equivalent for both instruments. Moreover, in Hiller et al.’s (1999) article, “A Comparative Meta-Analysis of Rorschach and MMPI Validity,” their findings indicate that the MMPI had larger validity coefficients than the Rorschach for studies using psychiatric diagnoses and self-report measures as criterion variables, whereas the Rorschach had larger validity coefficients than the MMPI for studies using objective criterion variables.
Additional Information: The Rorschach Inkblot Test
Which of the following therapeutic approaches refers to changing or adapting to the environment by altering one's own behaviors or responses? Select one: A. emic B. etic C. alloplastic D. autoplastic
Correct Answer is: D
Autoplastic (“self-change” ) refers to changing or adapting to the environment by altering one’s own behaviors or responses.
An emic perspective involves focusing on the intrinsic distinctions that are meaningful to members of a particular culture or society. An etic perspective involves focusing on extrinsic distinctions that have meaning for the observer of the culture or society. Alloplastic refers to changing or adapting to the environment by effecting changes in the environment.
In the transtheoretical model, “zero temptation and 100% self-efficacy” is:
Select one:
A. an unrealistic expectation of behavioral change.
B. the definition of successful behavioral change.
C. the result of complete behavioral change in the termination stage.
D. the result of ‘decisional balance’ in the maintenance stage.
Correct Answer is: C
Prochaska and DiClemente’s transtheoretical or stages of change model distinguishes between six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Many descriptions of the model only include the first five stages because the termination stage of “zero temptation and 100% self-efficacy” is not necessary for success and rare for most behaviors. Maintenance is when a person has maintained action, consolidates the change and is actively working to prevent a relapse. For many, the maintenance stage lasts forever and the model accepts temptation or the potential for relapse, such as an occasional craving for a cigarette or a drink, as normal and an opportunity to learn. At each stage, an individual weighs the pros and cons of adopting a new behavior, Prochaska and DiClemente called this weighing “decisional balance.”
The term “incongruence” as defined by Carl Rogers refers to a chasm between
Select one:
A. the real self and the ideal self.
B. self-as-object and self-as-process.
C. the perceived self-concept and the real self.
D. the person’s current maturity level and the person’s potential.
Correct Answer is: A
According to Carl Rogers’ theory, which underlies his person-centered approach to psychotherapy, the healthy person is one striving toward self-actualization, which means that he is open to experience, creative, trusting of his feelings, flexible in his self-concept, and striving to meet his full potential as a human being. He contrasted the self-actualizing tendency with incongruence, which refers to a conflict between the real (or perceived) self and the ideal self. Incongruence results from conditions of worth being placed on the person, by oneself and/or others, which means that the person is only positively regarded under certain conditions. By contrast, unconditional positive regard fosters the self-actualizing tendency, and Rogers identified unconditional positive regard–along with genuineness and empathy–as one of three therapist attitudes crucial to the success of person-centered therapy.
Additional Information: Theory of Personality and Pathology and Goals of Therapy (Client-Centered Therapy)
The tendency to attribute all behavioral, social and emotional problems to a diagnosis or psychopathology while alternative explanations and comorbid diagnoses are often not considered is referred to as: Select one: A. diagnostic overshadowing B. psychosocial masking C. intellectual distortion D. baseline exaggeration
Feedback
Correct Answer is: A
Research by Reiss et al. (1982) found mental disorders in individuals with mental retardation are often unrecognized, undiagnosed, and untreated. The underestimation was proposed to be the result of a phenomenon called “diagnostic overshadowing,” where the presence of mental retardation decreases the diagnostic significance of an accompanying mental health disorder. Or as an example with slow learners there may be the reverse case of diagnostic overshadowing. That is, professionals ignore the real world influences of low intelligence such as poor coping skills, poor social skills, repeated failure experiences and the risk factors associated with poverty and attribute all behavioral, social and emotional problems to psychopathology.
The other response choices are three of four non-specific factors associated with mental retardation that influence the diagnostic process: intellectual distortion, emotional symptoms are difficult to elicit because of deficits in abstract thinking and in receptive and expressive language skills; psychosocial masking, the effect of disabilities or limited social experiences on the content of psychiatric symptoms; cognitive disintegration, the tendency to become disorganized under emotional stress or a decreased ability to tolerate stress leading to anxiety-induced decompensation; and baseline exaggeration, the fact that chronic maladaptive behaviors may significantly increase in severity or frequency during a period of emotional stress or after the onset of psychiatric illness. (See: Reiss, S., Levitan, G.W., Szyszko, J. (1982). Emotional Disturbance and Mental Retardation: Diagnostic Overshadowing. American Journal of Mental Deficiency, 86(6), 567-74.)
In the MMPI-2, which of the following could be considered a suppressor variable? Select one: A. D B. F C. K D. L
Correct Answer is: C
Although correlated with other scores in a test, a suppressor variable is irrelevant to what is being measured by the test. Therefore, it can be used as a correction factor to partial out the effects of the irrelevant variable. In the case of the MMPI-2, the K scale serves as a measure of clinical defensiveness and can be used as a correction factor for several of the clinical scales.
Additional Information: K or “Correction” Scale (MMPI-2)
According to recent research studies, which of the following statements is most true regarding therapy with African-American clients conducted by Caucasian therapists?
Select one:
A. It is likely to be less effective as compared to therapy conducted by an African-American therapist.
B. The effectiveness of therapy is related to a number of client and therapist variables, such as the client’s suspiciousness of Caucasians in general and the therapist’s own racial identity development.
C. The effectiveness of therapy is likely to be enhanced if the therapist ignores racial issues in the early stages of therapy, but brings them up in the later stages of therapy after an alliance has been established.
D. Race is not likely to be an important issue in therapy with African-American clients.
Correct Answer is: B
Most research (especially recent research) suggests that client-therapist racial or ethnic similarity per se does not have a significant impact on therapy outcome. However, ethnic or racial matching does interact with a number of other variables in affecting outcome. For instance, recent research with African-American clients shows that cultural mistrust, or suspiciousness of Caucasians due to the historical animosity between the two racial groups, is negatively correlated with therapy effectiveness. Other research has suggested that Caucasian therapists’ own racial identity development is moderately correlated with their multicultural counseling skills.
The effectiveness of therapy is likely to be enhanced if the therapist ignores racial issues in the early stages of therapy, but brings them up in the later stages of therapy after an alliance has been established.
By the way, the opposite of this choice is true: The research suggests that the impact of cultural differences can be lessened if the therapist attends to and raises racial issues during the early stages of therapy.
Additional Information: Counseling African-American Clients
According to Derald Wing Sue’s locus of control and locus of responsibility theory, a person who gives up on getting a desirable job because he believes it is impossible to do so due to outside forces such as discrimination likely has a worldview of
Select one:
A. external locus of control, internal locus of responsibility.
B. external locus of control, external locus of responsibility.
C. internal locus of control, external locus of responsibility.
D. internal locus of control, internal locus of responsibility.
Correct Answer is: B
J.B. Rotter identified internal-external locus of control as a personality trait related to attributional tendency. People with an internal locus of control tend to view positive and negative outcomes as the result of their own actions; i.e., they believe they have control over their own fate. Those with an external locus of control view outside forces, such as luck or powerful external entities, as in control over what happens to them. Derald Wing Sue identified locus of responsibility as an additional attributional tendency. People with an internal locus of responsibility credit or blame themselves for what happens to them; those with an external locus of responsibility place credit or blame with others. According to Sue, one’s worldview can fall into one of four quadrants, based on their locus of control and locus of responsibility. For example, people with an internal locus of control and external locus of responsibility (IC-ER) might blame society for their problems, but believe that they have the ability to overcome these problems; this is the typical worldview of an activist or militant. Sue noted that IC-IR is the quadrant considered normal and healthy in the dominant culture, but that this is not necessarily the case in minority cultures. In this question, the person believes he has no control over his ability to get a job and blames the problem on discrimination. Therefore, he has an external locus of control and external locus of responsibility.
Additional Information: Worldview
An adolescent's behavior is motivated primarily by her needs for power and attention. Her problems would probably be best addressed by a therapist adopting the approach of: Select one: A. Adler. B. Ellis. C. Perls. D. Freud.
Correct Answer is: A
Probably the best way to approach this question is to see if the notions of power and attention are linked to any of the people listed in the responses. For Adlerians, a desire to belong is a primary motivator of behavior, but this desire may be channeled into the mistaken goals of power, attention, inadequacy, or revenge.
Additional Information: Alfred Adler’s Individual Psychology
Primary strategies or skills associated with \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ include open-ended questions, affirmations, reflective listening, and summary statements. Select one: A. interpersonal therapy B. motivational interviewing C. solution-focused therapy D. reality therapy
Correct Answer is: B
While the listed strategies are useful for most therapies, they are the stated primary strategies of motivational interviewing as they are considered helpful for increasing client motivation. There are five specific methods useful throughout the process of motivational interviewing. The first four are represented by the acronym OARS: open-ended questions, affirmations, reflective listening, and summarizing. These methods are largely derived from a client-centered approach and are utilized to explore client ambivalence and clarify reasons for change. The fifth method, “eliciting change talk” , is specific to motivational interviewing and describes its directive nature. This strategy integrates and guides the use of the other four. (Note it is also appropriate sometimes to ask closed-ended questions, change the focus, provide information, state an opinion, give advice when requested, etc. in addition to these foundational skills to enhance client motivation.)
Additional Information: Motivational Interviewing
A self-report inventory that assesses general psychiatric symptoms on a Likert-type scale is the: Select one: A. MCMI-III B. Rorschach C. MMPI-II D. SCL-90
Correct Answer is: D
The Symptom Checklist 90 (SCL-90) is a self-report inventory assessing general psychiatric symptoms of anxiety, depression, somatization, obsessive-compulsiveness, and hostility. Clients respond to the stimulus term, such as “feel nervous inside” on a 5-point Likert type scale from “not at all” which gives a score of 0, to “extremely” which gives a score of 4.
Additional Information: Symptom Checklist 90 (SCL-90)
In contrast to feminist therapists, non-sexist therapists:
Select one:
A. emphasize the importance of therapist self-disclosure
B. focus more on individual change than social change
C. de-emphasize the effects of gender on personality development
D. stress the egalitarian nature of the therapist-client relationship
Correct Answer is: B
Note that this question is asking how non-sexist therapy differs from feminist therapy. A key distinction is that non-sexist therapy is more concerned with personal responsibility and personal change, while feminist therapy places equal or greater emphasis on the sociopolitical contributions to pathology and the need for social change.
Additional Information: Non-Sexist Therapy
A father and his 19-year-old son present for therapy due a variety of conflicts in their relationship. The father is a businessman and the son is an artist. What techniques would a solution-focused family therapist use?
Select one:
A. Joining and restructuring.
B. Paradoxical directives and reframing
C. Miracle and scaling questions
D. Non-directive listening and interpretation
Correct Answer is: C
Solution-focused therapists use a variety of techniques designed to identify solutions to client’s problems. The miracle and scaling questions are two such techniques used by solution-focused therapists. The miracle question invites the client to imagine what it would be like if his/her problem was suddenly gone. The scaling question invites each family member to rate a situation to see how the problem is perceived by others.
Joining and restructuring
Joining and restructuring is used by structural family therapists.
Paradoxical directives and reframing
Paradoxical directives and reframing is used by strategic family therapists.
Non-directive listening and interpretation
Non-directive listening and interpretation is used by object relations family therapists.
In gestalt therapy, transference would most likely be
Select one:
A. viewed as a distortion that interferes with here-and-now awareness.
B. viewed as a good way to learn about a client’s past relationships.
C. seen a sign that the client is not a good candidate for psychotherapy.
D. ignored.
Correct Answer is: A
Gestalt therapy is an experiential mode of psychotherapy that emphasizes personal responsibility and focuses on the person’s experience and awareness in the present moment (i.e., the here and now), as well as the environmental and social contexts in which experiences take place. In Gestalt therapy, an open, authentic patient-therapist relationship, in which the patient is expected to take responsibility for his or her own progress, is an important part of the process. In this relationship, Gestalt therapists focus on strengthening the contact boundary, or the degree to which the therapist and the client can engage in authentic dialog and contact while still maintaining the distinction between self and other. Transferences are seen as distortions in this boundary and in the awareness of what is actually occurring in the therapy situation. Transferences are not ignored in Gestalt therapy–they are explored and worked through as they arise, but unlike as in psychoanalysis, they are not encouraged.
Additional Information: Goals and Techniques of Gestalt Therapy
Which of the following variables is most strongly related to a preference for therapists of the same racial group in African-American psychotherapy clients? Select one: A. education B. IQ score C. racial/cultural identification D. presenting issue
Correct Answer is: C
Research shows that the stronger a client’s identification is with his or her racial or cultural background, the more likely he or she is to prefer a therapist from a similar background.
Additional Information: Therapist-Client Similarity (Other Variables)
Increased awareness is the primary goal of which of the following types of therapy? Select one: A. Self Psychology B. Reality Therapy C. Gestalt Therapy D. Existential Therapy
Correct Answer is: C
Although increased awareness can be considered an important goal of many types of therapy, it is perhaps most central to Gestalt Therapy. Gestalt therapy strives to increase an individual’s awareness of the self, the environment, and the nature of the self-environment boundary.
Additional Information: Goals and Techniques of Gestalt Therapy
Cross’s (1991) Black Racial (Nigresence) Identity Development Model includes the stage called Pre-Encounter. At this stage an African-American prefers a therapist
Select one:
A. of their own race.
B. of the Caucasian race.
C. of a minority group; but not African-American.
D. that is African, but not American.
Correct Answer is: B
Cross’s Identity Development Model includes four stages. The first stage is Pre-encounter in which whites are seen as the ideal, while African Americans are denigrated. The second stage or Encounter stage leads to an interest in developing an African-American identity and a preference for a therapist of one’s own race. The third stage (Immersion/Emersion) involves a struggle between old and emerging ideas about race. There is an initial idealization of African-Americans and a denigrating of whites. Toward the end of this stage the person becomes less emotionally immersed and moves toward internalization of a new identity. In the fourth and final stage (Internalization/Commitment), the individual adopts an African-American world view.
Additional Information: Black Racial Identity Development Model (Cross)
Therapist self-disclosure in feminist therapy:
Select one:
A. encourages participation by the client in the early stages of therapy.
B. promotes client passivity in the therapeutic relationship.
C. contributes to an egalitarian relationship between the client and therapist.
D. facilitates a special bonding between the therapist and the client.
Correct Answer is: C
One of the main characteristics of feminist therapy is its emphasis on an egalitarian relationship between the client and therapist. Feminist therapists consider self-disclosure with clients as a way of supporting an egalitarian relationship. Therapist self-disclosure may be used to encourage client participation, but this response isn’t as good as the correct option in describing the role of self-disclosure in feminist therapy. Feminist therapy discourages client passivity and feminist therapists typically discourage special bonding as it may encourage client dependence on the therapist.
An individual who is in the contemplation stage of change is:
Select one:
A. unaware of a problem.
B. aware of a problem, thinking of change.
C. intending to change.
D. working on modifying their behavior.
Correct Answer is: B
Prochaska and DiClemente’s transtheoretical, or stages of change, model is an eclectic model that integrates interventions from various theories of psychotherapy and distinguishes between six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Many descriptions of the model only include the first five stages because the termination stage of “zero temptation and 100% self-efficacy” is not necessary for success and rare for most behaviors. At each stage, an individual weighs the pros and cons of adopting a new behavior, which Prochaska and DiClemente called “decisional balance.” The first stage is “Precontemplation,” characterized by denial, resistance, and no plans to change. In the second stage, “Contemplation,” a person begins to recognize the benefits of change and, although somewhat ambivalent, plans to change within the next 6 months. This best describes the person in this question. In the third stage, “Preparation,” a person has decided to take action within the next 30 days and may have already begun to take small steps towards change. In the next stage, “Action,” the person is actively engaged in making changes or acquiring new behaviors. The final stage is the “Maintenance” stage, in which the person has maintained action for at least 6 months and is actively working to prevent a relapse.
Additional Information: Transtheoretical Model of Change
According to meta-analytic studies of psychotherapy,
Select one:
A. so few well-controlled studies have been done that no conclusions can be made concerning treatment outcome.
B. behavior therapy is better than psychoanalysis.
C. behavior therapy is the treatment of choice for phobias.
D. a person participating in therapy would have just as much chance of improving as a control subject.
Correct Answer is: C
The research on psychotherapy outcome is pretty consistent in its conclusions. Common findings include that therapy is generally effective for children and adults of all backgrounds and that, with the exception of certain specific problem areas, all therapies are about equal. This question is about one of those exceptions. According to outcome research, phobias respond best to behavioral techniques such as exposure treatments.
Additional Information: Other Issues in Therapy Outcome Research
From the perspective of psychoanalytic theory, mania represents:
Select one:
A. a biological illness that psychoanalysis can do nothing about.
B. acting-out of libidinous impulses.
C. a regression to an infantile state.
D. a defense against depression.
Correct Answer is: D
According to classical psychoanalytic theory, mania occurs as a defense against depression, due to an inability of the person to tolerate or admit to being depressed.
Additional Information: Defense Mechanisms
A feminist therapist would likely consider which intervention most essential?
Select one:
A. a lifestyle analysis
B. a functional assessment of a specific problem area.
C. social action
D. maintaining an anonymous role as a therapist
Correct Answer is: C
Whereas non-sexist therapy is more concerned with personal responsibility and personal change, feminist therapy places equal or greater emphasis on the sociopolitical contributions to pathology and the need for social change. The feminist approach to psychotherapy rests on the assumption that social roles and socialization are important determinants of behavior and that psychological conflicts are alternative roles and options. A primary goal of feminist therapy is empowerment or helping women become more self-defining and self-determining. One of the main characteristics of feminist therapy is its emphasis on an egalitarian relationship between the client and therapist. Feminist therapists consider self-disclosure with clients as a way of supporting an egalitarian relationship. Therapist self-disclosure may be used to encourage client participation. Feminist therapy discourages client passivity and feminist therapists typically discourage special bonding as it may encourage client dependence on the therapist.
Additional Information: Feminist Therapy
Schema therapy was developed to treat the chronic characterological aspects of disorders. A key aspect of this approach is the use of a technique referred to as: Select one: A. treatment failure reassessment B. early maladaptive schema C. limited reparenting D. emotive therapy
Correct Answer is: C
Schema therapy integrates elements of cognitive-behavioral, attachment, Gestalt, object relations, constructivist, and psychoanalytic therapy to treat chronic characterological aspects of disorders (versus acute psychiatric symptoms) by addressing the core psychological themes typical of individuals with characterological disorders. These core themes are referred to as “early maladaptive schemas” . Early maladaptive schemas are self-defeating emotional and cognitive patterns that begin early in development and repeat throughout life. Note, according to this theory maladaptive behaviors develop as response to schemas and are driven by schemas but are not part of schemas. The therapist works with clients in addressing their schemas utilizing cognitive, affective, behavioral, and interpersonal strategies including: exploring the therapist-client relationship, maladaptive coping styles and using emotive techniques. When clients repeat dysfunctional schema-based patterns, the therapist confronts them empathically with reasons for change and supplies a partial antidote to needs that were not adequately met in childhood. Through this “limited reparenting,” clients gain the ability to view their characterological problems as ego-dystonic and become more empowered to give them up. More recently schema therapy has also been blended with mindfulness meditation to add a spiritual dimension. Schema therapy has been found to be useful in treating chronic depression, anxiety, eating disorders, long-standing difficulties in maintaining intimate relationships and substance abuse relapse. (See: Young, J.E. (1990, 1999). Cognitive therapy for personality disorders: A schema-focused approach (revised edition). Professional Resource Press, Sarasota, Florida. And: Young, J.E., Klosko, J.S., & Weishaar, M. (2003). Schema Therapy: A Practitioner’s Guide. Guilford Publications: New York.)
Additional Information: Schema therapy
You are seeing a client who exhibits all the major symptoms of a Major Depressive episode. You should
Select one:
A. invite his wife in to aid in completing a more comprehensive family history.
B. assess for early child abuse.
C. refer him to a psychiatrist for a medical evaluation.
D. assess for recent deaths in his family.
Correct Answer is: C
While the other choices could be options, “all the major symptoms” should tip you off to your client’s level of distress. Standard 1.20 (Consultations and Referrals) states, “Psychologists arrange for appropriate consultations and referrals based principally on the best interests of their patients.”
Additional Information: Boundaries of Competence
Research on the use of mental health services by members of minority groups indicates that:
Select one:
A. utilization rates are lower for members of all minority groups than for whites.
B. utilization rates are higher for members of all minority groups than for whites.
C. utilization rates are higher for members of some minority groups and lower for members of other minority groups than for whites.
D. utilization rates for members of minority groups are about the same as the rates for whites.
Correct Answer is: C
It’s difficult to draw any general conclusions about utilization rates because the research findings are inconsistent. However, a 1991 study by Sue et al. (which is frequently cited in the literature) reports underutilization by Asian-and Latino-Americans and overutilization by African-Americans. The results of other studies also suggest that there are group differences in utilization rates, so this response (“utilization rates are higher for members of some minority groups and lower for members of other minority groups than for whites”) is the best.
Additional Information: Utilization of Mental Health Services by Minority Group Members
Classical psychoanalytic theory and the object-relations theories both emphasize
Select one:
A. the interaction between the id, the ego, and the superego.
B. the importance of separation and individuation in childhood.
C. the need for a therapist to “re-parent” the patient.
D. the role of early childhood experiences in personality development.
Correct Answer is: D
Both Freudian theory and object-relations theory stress the role of early childhood experience in personality development. Freud believed that adult personality hinges to a large extent on how conflicts (e.g., the oedipal conflict) are resolved in childhood, while the object-relations theorists posit that a child’s early experiences determine the development of his or her introjects (mental representations of self and others), which determine personality functioning as an adult.
the interaction between the id, the ego, and the superego.
This choice applies to Freudian theory.
the importance of separation and individuation in childhood.
This applies to object-relations theory.
the need for a therapist to “re-parent” the patient.
This applies to object-relations theory.
Additional Information: Object-Relations Theory
From the perspective of Beck's cognitive therapy, suicidal individuals are characterized by a high degree of hopelessness coupled with: Select one: A. maladaptive interpretations. B. poor problem-solving skills. C. the "cognitive triad." D. impulsivity.
Correct Answer is: B
This is a difficult question if you are not familiar with Beck’s work on suicide. Maladaptive interpretations and beliefs are, of course, an important focus in cognitive therapy regardless of the client’s problem. However, since this question is asking specifically about suicide, you’d want to choose the response that fits that problem. According to Beck, suicide risk is heightened by a combination of hopelessness and poor problem-solving skills.
Hand washing frequency by health care workers is low despite the importance of compliance for reducing rates of hospital-acquired infection. Research indicates the most effective interventions for increasing hand washing include:
Select one:
A. continued performance feedback and written materials
B. education, continued performance feedback and reminders
C. automated sinks, education and availability of moisturizing soap
D. automated sinks, written materials and reminders
Correct Answer is: B
Studies on interventions to increase compliance with hand hygiene practices have found that no single intervention has consistently improved handwashing frequency in healthcare workers. Individual intervention findings indicate: one-time educational interventions and performance feedback on compliance rates are associated with a short-term influence; distribution of written materials and strategically placed reminders had a modest but more sustained effect; automated sinks increased the quality of handwashing however decreased the frequency; and the availability of moisturizing soaps had little or no effect on frequency. Research suggests the most effective approach is a multifaceted one that includes education in combination with written material, reminders and continued feedback of performance. The availability of an alcohol-based hand gel, when added to the multifaceted approach also appears to result in a modest improvement in compliance. (See: Naikoba, S. & Hayward, A. (2001). The effectiveness of interventions aimed at increasing handwashing in healthcare workers - a systematic review. Journal of Hospital Infection. 47, 173-180.)
A Latina is most likely to experience her symptoms of depression as a Select one: A. spiritual or physical problem. B. family problem. C. woman's problem. D. mental or emotional problem.
Correct Answer is: A
While psychological problems are often experienced as “emotional” by Anglos, members of a number of minority groups (including Latinos) often experience them as physical or spiritual in origin.
Additional Information: Counseling Hispanic Clients
A therapist is working with a newly arrived refugee client about her difficulties in acculturation. The therapist does not have firsthand experience as a refugee or immigrant, but knows what it is like to move from one city to another, transfer employment, lose work, and experience the loss of family or friends. That the therapist is able to understand, accept, and feel the client's situation, while simultaneously maintaining a separate sense of cultural self is an example of: Select one: A. cultural encapsulation B. cultural universality C. active empathy D. cultural empathy
Correct Answer is: D
Cultural empathy means a therapist understands and appreciates cultural differences in a way that extends the boundaries of traditional empathy, retaining his or her separate cultural identity while simultaneously aware of and accepting the cultural values and beliefs of the client. It is a way of relating interpersonally with the ability to accurately understand the experience of culturally diverse clients and the ability to communicate this understanding effectively with an attitude of concern across cultures.
Cultural encapsulation, according to Gilbert Wrenn (1962), refers to when a therapist defines reality according to one set of cultural assumptions, becomes insensitive to cultural variations, disregards evidence disproving their assumptions, depends on technique-oriented or quick-fix solutions to problems and judges others from their own self-reference criteria. Cultural universality refers to the assumption that Western concepts of normality and abnormality can be considered universal and equally applicable across all cultures. Active empathy* refers to when therapists actively communicate appreciation about all aspects of clients’ lives (* incorrect options).
Additional Information: Cultural Empathy
Minuchin, the founder of structural family therapy, defines “triangulation” as occurring when
Select one:
A. the child and one parent “gang up” on the other parent.
B. the parents either consistently attack or protect the child.
C. each parent demands that the child side with him/her.
D. two members of the family consistently challenge the therapist’s authority.
Correct Answer is: C
Minuchin defines three types of “rigid triangles” that involve chronic boundary disturbances - triangulation (“each parent demands that the child side with him/her”); detouring (“the parents either consistently attack or protect the child”); and a stable coalition (“the child and one parent ‘gang up’ on the other parent”).
Additional Information: Theoretical Constructs: Structural Family Therapy
When patients bring medical information they have accessed on the Internet to a doctor’s visit, the doctor-patient relationship is most likely to suffer if
Select one:
A. the physician feels that the patient is challenging the authority of the physician.
B. the patient brings inaccurate information.
C. the patient makes a clinically inappropriate request for medication based on the information.
D. the physician is not very “tech-savvy.”
Correct Answer is: A
According to a survey of physicians in the United States, a large percentage of patients bring medical information they have accessed on the Internet to doctor’s visits. The survey found that the doctor-patient relationship could be harmed if this information is inaccurate, or if the physician feels his or her authority is being challenged. However, the latter factor, physicians’ perceptions of a challenge to their authority, was a stronger predictor of harm to the relationship than any other factor. This factor was also the strongest predictor of deterioration in health outcomes and the quality of care received.
All of the following are true regarding Feminist Object Relations Theory except:
Select one:
A. it emphasizes the importance of the maternal relationship with the child.
B. it proposes that gender differences are the result of girls being taught to remain attached to their mothers while boys are taught to separate from their mothers.
C. it proposes that girls develop a healthier self-object when raised primarily by their father due to earlier separation from their mother.
D. it proposes that mothering “reproduces itself” since mothers perpetuate the oppressiveness of the division of labor.
Correct Answer is: C
Nancy Chodorow was one of the first to apply a feminist perspective to an Object Relations model. In The Reproduction of Mothering (Berkeley, University of California Press, 1978) she focused on the relationship between mother and child and how gender differences result from the mother being the primary caretaker. The division of labor which occurs in families (although less so in recent years), is characterized by women being more involved in affective, interpersonal relationships than men. This is inevitably passed on to both boys and girls who ‘reproduce’ this sexual and familial division of labor.
Additional Information: Feminist Object-Relations Theory
Cultural differences and factors have an influence on the manifestation of client symptoms. If a psychologist assumes an Asian client's somatic complaints are really reflective of a mental disorder it is an example of: Select one: A. demand characteristics B. diagnostic overshadowing C. the fundamental attribution bias D. self-perception bias
Correct Answer is: B
Diagnostic overshadowing is a term to describe when a therapist’s ability to recognize or consider other symptoms or conditions is “overshadowed” by one aspect of a client’s symptoms or condition.
Demand characteristics* are unintentional cues in the experimental environment or manipulation that allow participants to guess the hypothesis and, as a result, participants may behave differently than they would under normal conditions. The fundamental attribution bias* refers to the tendency to overestimate dispositional (personality) factors and underestimate situational factors in explaining the behavior of others. Self-perception bias* refers to an individual inferring what their internal state is by perceiving how they are acting in a given situation (* incorrect options).
Additional Information: Diagnostic overshadowing
According to Sue and Sue’s Racial/Cultural Identity Development Model, a person in the dissonance stage would experience:
Select one:
A. appreciation of the self and depreciation of the dominant group
B. depreciation of the self and appreciation of the dominant group
C. appreciation of the self and the dominant group
D. conflict between appreciation and depreciation of the self and the dominant group
Correct Answer is: D
Even if you were unfamiliar with Sue and Sue’s Racial/Cultural Identity Development Model, you may have been able to guess correctly if you realized that the term “dissonance” refers to conflict. Sue and Sue’s (1990) Racial/Cultural Identity Development Model (R/CID) is an elaboration of the Minority Identity Development model (MID) proposed by Atkinson, Morton, and Sue (1989). Both models describe the same stages (conformity, dissonance, resistance and immersion, introspection, and integrative awareness) but the R/CID model elaborates on individuals’ attitudes toward self and others. During the Conformity stage, a person depreciates the self (and others of the minority group) but appreciates the dominant majority group. During the Dissonance stage, minority individuals experience conflict between appreciation and depreciation of the self and the majority group. In the Resistance and Immersion stage, the individual appreciates the self and depreciates the majority group. In the Introspection stage, the person again experiences conflict and questions the basis of his or her appreciation and depreciation of self and others. And, finally, in the Integrative Awareness stage, the person experiences self-appreciation and selective appreciation of the majority group [D. W. Sue and D. Sue, Counseling the culturally different: Theory and practice, 3rd edition, 1999, New York, John Wiley].
Additional Information: Minority Identity Development Model
According to Janet Helms' (1995) White Racial Identity Development Model, the fourth status of racial identity development is: Select one: A. immersion-emersion B. disintegration C. reintegration D. pseudo-independence
Correct Answer is: D
Helms’ White Racial Identity Model (1984, 1995) consists of two Phases (Abandonment of Racism and Defining Non-racist White Identity) with six specific racial identity statuses equally distributed between the two phases: 1) Contact Status, 2) Disintegration Status, 3) Reintegration Status, 4) Pseudo-independence Status, 5) Immersion/Emersion Status, and 6) Autonomy Status. The first status, “contact” , is characterized by ignorance and disregard of any racial differences. The next stage, “disintegration” *, involves awareness of racial inequalities which results in moral confusion and conflict. The third status, “reintegration” *, involves Whites being viewed as superior to minorities. Next is “Pseudo-Independence” , which is marked by dissatisfaction with reintegration. Then is “Immersion-Emersion” , during which people embrace their whiteness without rejecting minorities ( incorrect options). The last status, “Autonomy” , is reached when a person internalizes a nonracist White identity, whereby similarities and differences are acknowledged but are not perceived as threatening.
Additional Information: Helms’ Racial Identity Models
One of the most consistent findings of the research on client factors in the therapy process is that
Select one:
A. more seriously disturbed clients have better outcomes in therapy.
B. higher levels of intelligence predict better therapy outcomes.
C. age is significantly related to therapy outcome.
D. men are more likely to seek therapy.
Correct Answer is: B
One of the most consistent findings of the research on client factors is that higher levels of intelligence predict better therapy outcome (Luborsky, 1989).
more seriously disturbed clients have better outcomes in therapy.
This answer is incorrect because seriously disturbed individuals actually have poorer outcomes (Garfield, 1994).
age is significantly related to therapy outcome.
Age appears to be unrelated to therapy outcome.
men are more likely to seek therapy.
This would have to state that women are more likely to seek therapy to be correct (Luborsky et al., 1989).
Additional Information: Client Variables
Despite his many accomplishments and positive feedback from his supervisor, a client believes his work performance is below average because he feels like a failure. This is an example of: Select one: A. minimization B. selective abstraction C. emotional reasoning D. personalization
Correct Answer is: C
Emotional reasoning is one of several cognitive distortions described by Beck. It refers to a person believing that because he or she feels a negative emotion, there must be a corresponding negative external situation.
minimization
Minimization is seeing something as less significant than it really is.
selective abstraction
Selective abstraction occurs when one focuses on a detail, taken out of context, at the expense of other information.
personalization
Personalization is the attribution of external events to oneself without evidence of a causal connection.
Additional Information: Cognitive Distortions
Which of the following is NOT true regarding the Halstead-Reitan Neuropsychological Test Battery?
Select one:
A. It provides information on a range of cognitive strengths and weaknesses.
B. It can usually be completed within 45 to 60 minutes.
C. It must be administered by a highly trained examiner.
D. The results are reflected in a combined score known as the Impairment Index.
Feedback
Correct Answer is: B
The Halstead-Reitan Neuropsychological Test Battery is a set of tests designed to assess attention, language, memory, abstract thinking, motor speed, and spatial reasoning (“range of cognitive strengths and weaknesses”). The purpose of the test is to provide an overall assessment of brain function. The battery must be administered by a highly trained examiner. The results of each subtest are combined into an Impairment Index. However, contrary to the correct choice (which is an incorrect statement), the battery usually requires 4 to 5 hours to administer.
Additional Information: Halstead-Reitan (H-R)
Hypnosis would least likely be used in the treatment of: Select one: A. Substance Abuse. B. Obsessive-Compulsive Disorder. C. Specific Phobia. D. chronic pain.
Correct Answer is: B
Hypnosis is contraindicated in individuals who have difficulty giving up control, such as obsessive-compulsive patients, or those who have difficulty with basic trust, such as paranoid patients. By contrast, hypnosis is often employed in the treatment of the other disorders. In the treatment of Substance Abuse, varying degrees of success have been reported; however, it continues to be used. It is also commonly used to help induce relaxation and/or gain access to painful memories in treating individuals with Anxiety Disorders; moreover, according to some, it is particularly effective in treating individuals with Specific Phobia because they are highly hypnotizable. Finally, hypnosis is also commonly used in the treatment of medical conditions that have a psychological component such as asthma, chronic pain, obesity, etc.
In their often-cited research study, Sue and his colleagues (1991) found that ethnic matching of therapist and client:
Select one:
A. improves therapy outcome and reduces premature termination for African-American clients but not for Asian-American or Mexican-American clients.
B. improves therapy outcome and reduces premature termination for Asian-American and Mexican-American clients but has less of an effect on these variables for African-American clients.
C. substantially improves therapy outcome and reduces premature termination for Asian-Americans, Mexican-Americans, and African-Americans.
D. is related to premature termination for African-Americans and Whites but has little or no impact on other measures of treatment outcome.
Correct Answer is: B
This is a difficult question because the research is so inconsistent on this issue. However, this question is referring to a specific study, which makes it easier as long as you’re familiar with that study’s results. One of the things that Sue and his colleagues learned was that the effects of ethnic matching differ for different minority groups. Specifically, ethnic matching seems most beneficial for Asian- and Hispanic-Americans, so this response best summarizes their findings.
Additional Information: Therapist-Client Similarity
From the perspective of humanistic schools of psychology, psychopathology would be seen as being due to:
Select one:
A. man’s irrational nature, which interferes with a disciplined course of behaviors to enhance personal growth.
B. defenses that interfere with one’s own natural tendency toward personal growth.
C. biological factors that inhibit personal growth.
D. a lack of insight into one’s past, which interferes with the tendency toward personal growth in the present.
Correct Answer is: B
The humanistic school of psychotherapy, which is exemplified by approaches to therapy such as person-centered therapy, Gestalt therapy, and transactional analysis, emphasizes human capacities and potentialities rather than deficiencies. From the humanistic perspective, we have a natural tendency toward self-actualization or personal growth. Neurosis or pathology occurs due to defensive distortions (e.g., blocks to awareness in Gestalt therapy, or conditions of worth in person-centered therapy) that prevent this natural tendency from operating.
Additional Information: Theory of Personality and Pathology and Goals of Therapy (Client-Centered Therapy)
The term "success identity" is associated with: Select one: A. Eric Berne B. William Glasser C. Fritz Perls D. Carl Rogers
Correct Answer is: B
According to Glasser’s Reality Therapy, when an individual is capable of fulfilling his or her own needs for survival, power, belonging, freedom and fun, without harming self or infringing on the rights of others, then he or she has developed a “success identity.” When the needs are met irresponsibly then the individual has developed a “failure identity.”
Bern is associated with transactional analysis (TA); Perls is associated with gestalt therapy; and Rogers is associated with client-centered therapy.
