Case Conceptualization and Planning Flashcards
Which of the following types of therapy would be contraindicated for a client diagnosed with Avoidant Personality Disorder?
Select one:
A.
client-centered therapy
B.
cognitive-behavioral therapy
C.
Gestalt therapy
D.
supportive therapy
Gestalt therapy
Generally, for clients with Avoidant Personality Disorder, supportive therapy combined with cognitive-behavioral techniques is the preferred treatment modality. Gestalt therapy usually works best with clients who have a high degree of ego strength and can benefit from confrontive techniques. People with Avoidant Personality Disorder typically are too insecure and afraid of criticism or rejection to participate successfully in Gestalt therapy.
Your new client is a man whose wife was raped. He reports feeling overwhelmed and confused, wanting to be supportive but also feeling sexually distant from his wife. She is in treatment with another therapist. Your best initial intervention would be to:
Select one:
A.
call the wife’s therapist to consult and coordinate treatment.
B.
bring the wife into couple therapy with you and her husband.
C.
refer your client to a group for men whose partners have been sexually assaulted.
D.
normalize your client’s feelings and continue individual therapy.
C. Refer your client to a group for men whose partners have been sexually assaulted.
Partners of rape victims often have conflicted feelings and being in a group with others facing a similar situation will help the client feel normal and reduce his sense of isolation. The group may also help the client better understand what his wife is going through.
Answer A is incorrect: Consulting and collaborating with the wife’s therapist (with appropriate permission) is possible but does not directly address the client’s feelings and concerns.
Answer B is incorrect: The wife may have too many individual issues to be available for couple therapy.
Answer D is incorrect: Normalizing the man’s feelings and continuing with individual therapy is not a sufficient response to his current concerns.
A client begins to cry during his first session with you. Your BEST action would be to:
A.
reassure him that he will feel better since he has sought therapy.
B.
sit with him quietly until he is ready to speak.
C.
gently ask open-ended questions so you can find out why he is crying.
D.
ask him if you can come and sit beside him.
B. Sit with him quietly until he is ready to speak.
In many forms of psychotherapy, the client is encouraged to fully experience and express his or her feelings. Thus, when the client begins to cry, you would not want to interrupt his expression, at least not at first. As suggested by this answer more than any of the other responses, you would just want to let him cry.
Answer A is incorrect: This would probably seem disingenuous to the client.
Answer C is incorrect: This would be appropriate once the client has had an opportunity to cry, but it is less appropriate than answer B because it suggests you would immediately interrupt the client’s expression of his feelings.
Answer D is incorrect: Especially in an initial session, this may make the client uncomfortable and inhibit his ability to express his feelings.
Your new client is a teenager who tells you he was recently in a car accident with four of his friends. One friend died and two were seriously injured. You should first:
Select one:
A.
explore his underlying beliefs about his role in the accident.
B.
validate his feelings of guilt.
C.
talk to him about drinking and driving.
D.
allow him to feel the emotions he has about the accident.
D. Allow him to feel the emotions he has about the accident.
This question provides very little information about the teenager, so you want to avoid making any assumptions. This is the best answer because it is the most general one and makes no assumptions about what is going on with this client.
Answer A is incorrect: This may be appropriate later in treatment but, at this point, you need more information.
Answer B is incorrect: This is not the best answer since there is no indication in the question that the client feels guilty.
Answer C is incorrect: You might want to do this later in therapy but, at this point, you don’t even know if alcohol was involved.
When a child’s Specific Phobia involves a fear of and refusal to go to school, the first intervention should ordinarily be which of the following?
Select one:
A.
begin family therapy
B.
identify the reinforcement for nonattendance
Incorrect
C.
temporarily remove the child from the school environment
D.
get the child back to school as soon as possible
D. Get the child back to school as soon as possible
This is the commonly accepted first intervention when treating school phobia. The child should also be praised at the end of the school day for the progress he or she has made.
Answer A is incorrect: This might be useful later if the cause of the child’s phobia is related to family issues, but it is not the recommended first step.
Answer B is incorrect: This is an important part of the assessment, but it is not the first intervention.
Answer C is incorrect: This may be a mistake because, by keeping the child at home, you may be reinforcing his or her non-attendance at school, and it may become even more difficult to get the child back to school.
Paulette, a 35-year-old paralegal, has never been married. She has come to see you because she is feeling “devastated” over having just broken up with Stuart, one of the married attorneys for whom she works. When he was separated from his wife, she and Stu lived together for about three months, but Stu has since gone back to his wife. The realization that she was so attached to him has hit her hard, and she tells you that she does not know how she can go on with the “chaos in her life” resulting from the lost relationship. She says that Stu has recently accused her of acting “weird and inappropriate,” and she wonders if she is a “schizophrenic or something.” Assuming that you determine that Paulette meets the diagnostic criteria for borderline personality disorder, which treatment approach is likely to be most effective?
Select one:
A.
client-centered therapy
B.
dialectic behavioral therapy
C.
solution-focused therapy
D.
strategic family therapy
B. Dialectic behavioral therapy
Two psychotherapeutic approaches have been shown in randomized controlled trials to have efficacy for borderline personality disorder: dialectical behavior therapy and psychoanalytic or psychodynamic therapy. The treatments provided in these trials had three key components: weekly meetings with an individual therapist, one or more weekly group sessions, and meetings of therapists for consultation or supervision.
During the initial stage of therapy, the MOST important task is to:
Select one:
A.
establish rapport with the client.
B.
use mimesis to join with the client.
C.
assess the client’s needs using a genogram.
D.
determine the client’s diagnosis.
A. Establish rapport with the client.
Several tasks must be accomplished during the initial stage of therapy, and one of the first tasks is developing a good therapeutic relationship by establishing rapport and building trust.
Answer B is incorrect: This answer is not correct because using mimesis to join with the client is specific to structural family therapy, and the question is seeking a more general answer.
Answer C is incorrect: This answer is not the best one since constructing a genogram is specific to Bowenian therapy and other approaches that are concerned with family-of-origin issues.
Answer D is incorrect: Identifying the client’s diagnosis comes after establishing rapport and completing several other tasks including gathering initial assessment information.
A couple has been referred to you by their M.D. They have been married for six months and report that they are “really happy together.” There are no apparent medical problems and both of them seem to have a positive outlook on life and their marriage. The problem, as reported by the M.D., is that the woman is unable to have orgasms with intercourse alone. You would FIRST:
Select one:
A.
explain the difference between vaginal and clitoral orgasms.
B.
begin counseling the couple on their relationship.
C.
find out if this is a problem for the couple and what they have done so far to change things.
D.
construct a genogram to identify messages regarding sexuality in their families of origin.
C. Find out if this is a problem for the couple and what they have done so far to change things.
Your initial action should be to determine if the wife’s lack of orgasm with intercourse alone is viewed as a problem for this couple. If they stated that they want to change their sexual patterns, you would then ask them what they have already tried.
Answer A is incorrect: Although providing the couple with information could certainly be useful later, you must first determine exactly what they consider their problem to be.
Answer B is incorrect: This could be useful but not as a first step.
Answer D is incorrect: This might be useful, depending on what else you find out about the couple, but not as a first step.
Donald, age 15, was referred for family therapy by the probation department. During the family’s initial interview, Donald’s father says he is angry and resentful about having to be in therapy since this is “not my problem.” What would you do FIRST?
Select one:
A.
Respect the father’s position but deal with his emotions in future sessions.
B.
Acknowledge the father’s position.
C.
Tell the father you’ll exclude him from future sessions since his son has the problem and is on probation.
D.
Tell the father it’s imperative that he attend sessions since a son’s problems often have their root in the father-son relationship.
B. Acknowledge the father’s position.
The question asks what you would do first and, given the information presented in the question, acknowledging the father’s feelings would be the best initial response. You may determine later that the father is part of the “problem,” but acknowledging his feelings would not exonerate him from blame.
Answer A is incorrect: This is not a bad answer, but it’s not as good as answer B because it does not deal with the father’s immediate feelings. You can respect his position but also address his emotions during this session.
Answer C is incorrect: The father may be part of the problem, so this would not necessarily be a good intervention. If the boy’s acting-out behaviors reflect systemic dysfunctions, you will want to involve Dad in treatment.
Answer D is incorrect: This is not the best answer because responding to the father’s feelings by suggesting that he may be responsible for his son’s problems in this initial session may alienate him further.
A client you have been seeing for over three months has missed several appointments and called you at the last minute to cancel. When she does come in, she is usually late and provides little information. You should:
Select one:
A.
seek consultation for possible countertransference.
B.
refer her to another therapist.
C.
tell her the consequences that may occur if her tardiness and lack of participation continues.
D.
discuss her tardiness and lack of participation with her.
D. Discuss her tardiness and lack of participation with her.
This is the best choice since it seeks, in a non-punitive way, to explore the client’s behavior, which may provide important information about the client’s presenting problem and her progress in therapy.
Answer A is incorrect: Since the question does not mention your reaction to the client, there is no indication of countertransference.
Answer B is incorrect: Although this may be the final resolution, there are issues that need to be explored before taking this step.
Answer C is incorrect: This is not the best answer because it sounds punitive.
The Green family consists of a stepfather, age 50, a mother, age 35, and daughter Susie, age 10. Mr. and Mrs. Green have been a couple for about a year and married two months ago. They recently moved into a new house, which they are now remodeling. Susie is in a new school. The family has no contact with Susie’s biological father, an alcoholic who left the mother when Susie was two. The presenting problem is that Susie recently started setting small fires in trash cans at her school. When asked why, she appears confused and does not acknowledge what she did. Mr. and Mrs. Green report that, at home, Susie seems “a bit out of it” these days but that she’s usually a quiet, well-behaved child. What would be an important FIRST step to take in treating this family?
elect one:
A.
Attempt to make contact with Susie’s biological father since it appears she has been emotionally damaged by his absence.
B.
Begin play therapy with Susie to offer her alternative means of expressing her feelings.
C.
Educate the parents about the effects of remarriage on children.
D.
Refer Susie for a psychiatric evaluation to rule out organic causes for her behavior.
D.
Refer Susie for a psychiatric evaluation to rule out organic causes for her behavior.
Susie’s fire setting and reaction to your questioning could signal a number of problems or disorders. It would be necessary, however, to investigate whether biological factors are contributing to her behavior before assigning a diagnosis or offering any form of psychotherapy.
Answer A is incorrect: This seems unimportant since Susie’s problem, if it is non-organic, is more likely to be related to the recent stressors in her life (i.e., she has just started setting fires).
Answer B is incorrect: This might be appropriate if Susie’s problems do not have an organic cause.
Answer C is incorrect: This might be appropriate if Susie’s problems are not organically based.
Sue and Frank seek the assistance of an MFT for divorce counseling. They are both in their early 20’s and have been married for just over a year. They say they want a divorce because they do not feel the same way they did about each other before the marriage and have started arguing about household chores. Sue recently received a promotion and has begun coming home late from work, and Frank feels disappointed that he has to eat dinner alone so often. They are seeking counseling so that they will be able to part on good terms and avoid a messy divorce. The MFT should:
Select one:
A.
assist them in attaining their goal by helping them communicate their individual needs and refer them to a divorce mediator.
B.
explain to the couple that divorce does not seem necessary at this time.
C.
construct a genogram to establish whether either of them has a familial pattern of communication problems.
D.
educate the couple about the myths and realities of marriage and help them acquire better communication skills.
D.
educate the couple about the myths and realities of marriage and help them acquire better communication skills.
This direct approach would best serve the couple because it will immediately normalize their marital problems. It offers them an alternative perspective as well as behavioral options that will allow them to either work on their marriage or divorce amicably. Further, with this information, the couple can make an informed choice about whether divorce is their best course of action.
Answer A is incorrect: It would be more appropriate to educate the couple about the myths and realities of marriage first so that they can make an informed decision about their marriage.
Answer B is incorrect: Even though this might be true, it would be more beneficial therapeutically (as well as more ethical) for the MFT to intervene in a way that allows the couple to come to this conclusion themselves.
Answer C is incorrect: This might be appropriate later if the couple agrees to work on their marriage.
Mary, a single mother, age 35, and her 13-year-old son, Justin, have been referred by his middle-school counselor. Justin has been having problems at school for several months and was recently been suspended for bringing a knife to school. Mary has been divorced for one year. Justin sometimes visits his father on weekends and Justin’s problems are worse when he returns from those visits. You have received permission to treat Justin from both of his parents. The most effective treatment unit would be:
Select one:
A.
Justin alone for behavioral changes at school since he was referred to you by the school
B.
Justin and Mary for behavioral changes at home that will also influence his school behavior
C.
Mary and Justin’s father for parenting skills training to help them both set limits with Justin’s bad behavior
D.
Justin and both parents for family therapy since his behavior seems to be poor adjustment to his parent’s divorce
D.
Justin and both parents for family therapy since his behavior seems to be poor adjustment to his parent’s divorce
This question is asking for the most effective treatment unit. This (the family) is the best treatment unit for what is clearly a crisis, even though the reason given in the answer might not be the best.
Answer A is incorrect: Justin’s action of bringing a knife to school needs serious consideration beyond what an MFT would do with a child referred for other less serious offenses.
Answer B is incorrect: This treatment unit does not include Justin’s father. However, there is an indication in the case study that Justin’s visits with his father are inconsistent and that there are problems when he returns.
Answer C is incorrect: This answer can be easily eliminated since it doesn’t include Justin as a member of the treatment unit.
Your client witnessed an armed robbery at a bank in which the man next to him was shot. He has been diagnosed with PTSD because he is having flashbacks and intrusive thoughts and has avoided going to the part of town where the robbery occurred. Which factor would make it most difficult to devise a treatment plan for someone with this diagnosis?
Select one:
A.
intrusive recollections
B.
inability to disclose family history
C.
impaired ability to provide information about one’s family history
D.
reckless or self-destructive behavior
D.
reckless or self-destructive behavior
Reckless or self-destructive behavior is listed in the DSM-5 as a possible symptom of alterations in arousal and reactivity, and these behaviors would make treatment planning difficult. Often, reckless or self-destructive behavior takes the form of substance abuse which would also hinder treatment planning.
Answer A is incorrect: Intrusive recollections are part of the diagnostic picture for PTSD but would not necessarily impede the development of a treatment plan as much as reckless or self-destructive behavior.
Answer B is incorrect: This is the least likely answer and one you may have been able to easily eliminate.
Answer C is incorrect: An impaired ability to provide information about one’s family history sounds more characteristic of a Dissociative Disorder.
When treating an incestuous family system, which of the following interventions would be your LOWEST priority?
Select one:
A.
couples therapy for the parents
B.
reporting the abuse of minor victim(s)
C.
aversion therapy for the abuser
D.
supportive therapy and education for the victim(s)
C.
aversion therapy for the abuser
This is a difficult question because you are not given any information about the family other than the incest. However, aversion therapy of the abuser would not be an immediate intervention if you are working with the entire family.
Answer A is incorrect: This intervention can be important since working on the marital relationship might provide a defense against future incest.
Answer B is incorrect: This is probably the most important intervention.
Answer D is incorrect: The victim(s) would likely benefit from support and education.
