Case Conceptualization and Planning Part 2 Flashcards
Your new clients are recently divorced and came to see you for therapy because they can’t agree about their current custody arrangement. The father sees his child every other week but feels that it is not enough to sustain a relationship with him. The mother’s argument is that it would be damaging to the boy to make any changes in the custody arrangement at this time. You should:
Select one:
A. mediate a compromise that is sensitive to the best interests of the mother, father, and child.
B. suggest ways that the couple can change the court order regarding custody.
C. educate the couple regarding custody laws and the best interests of children.
D. allow them to express their feelings, vent unfinished business from the divorce, and then ask them to consider their child’s best interests.
Answer D is correct: Of the answers given, this is the only one that is clearly within an MFT’s scope of practice and addresses the bests interests of the mother and father. The parents need to be heard and understood as well as reminded of their child’s welfare.
Answer A is incorrect: A mediator does this, but it is not clear whether you have the appropriate training in this area. Also, the question states that the couple has come for therapy, not mediation. The best option would be to refer the couple to a mediator and continue therapy, but this is not given as an answer.
Answer B is incorrect: This response does not fall within an MFT’s scope of practice and could be viewed as siding with the father against the mother.
Answer C is incorrect: This response has some merit. However, at this point, you should allow the couple to process their feelings and rely less on information-giving.
A couple starts therapy to help them improve their relationship. During the first session, you notice that the husband is extremely critical of his wife. You should:
Select one:
A. ask the husband to repeat his remarks and then examine them along with the couple.
B. ask the wife how she feels about her husband’s destructive style of communication.
C. ask the husband to be less critical of his wife.
D. observe the couple for a few more sessions before broaching the topic of the husband’s communication style.
Answer A is correct: To some extent, your response would depend on your theoretical orientation and the goals of therapy. However, most forms of family and couple therapy include improving communication as a goal, and most experts emphasize the importance of identifying dysfunctional communication patterns early in therapy. In the situation described in this question, the therapist should, along with the couple, identify and examine current patterns of communication.
Answer B is incorrect: Labeling the husband’s communication style as destructive is overly confrontative.
Answer C is incorrect: Asking the husband to be less critical is too directive, especially in the first session.
Answer D is incorrect: It would be less useful to wait until later sessions of therapy to address this issue.
A client who meets the diagnostic criteria for major depressive disorder says she feels worthless and unlikable and every time she tries to do something to make things better, she is faced with barriers put up by her parents, boss, and others who do not seem to recognize her efforts. In terms of the third component of Beck’s cognitive triad, you would expect the client to also say that:
Select one:
A. other people are “out to get” her.
B. she had “a lousy childhood.”
C. she feels that things will never change.
D. nothing seems to make her feel good.
Answer C is correct: This client’s statements reflect a negative view of the self and the world, which are two of the three elements of Beck’s cognitive triad. The third element is a negative view of the future. According to Beck, depressed people feel that failures, disappointments, etc. will never stop or change.
The correct answer is: she feels that things will never change.
Mary Jones, age 75, was recently diagnosed with Alzheimer’s disease. She wants to include her daughter, son, and grandchildren in therapy with her. Which of the following questions is most important for the therapist to consider when determining the unit of treatment?
Select one:
A. Is Mary competent to make decisions?
B. Clinically, who should be in control of that decision?
C. Is Mary’s family willing to be involved and are they capable of being supportive?
D. Does Mary’s insurance cover family therapy?
Answer C is correct: The information provided in the question makes it clear that the client wants her family to be a part of the treatment unit. When deciding the appropriateness of this, the MFT would want to consider whether Mary’s family is willing and capable of being supportive members of Mary’s treatment.
Answer A is incorrect: The therapist’s choice of the treatment unit may be affected by Mary’s competence. However, Mary is apparently in the early stages of Alzheimer’s disease (she came to therapy alone and expressed an interest in including her family in therapy), and the question does not describe Mary as being unable to make competent decisions.
Answer B is incorrect: This answer is not the best answer because it is unclear – i.e., what is meant by being “clinically in control of the decision” about the unit of treatment?
Answer D is incorrect: The decision about the appropriate unit of treatment should not be based on insurance coverage but, instead, on the best interests of the client(s).
Your new client is from a small developing nation. You are unfamiliar with the client’s culture, and you acknowledge this to the client. She tells you that she wants help finding a way to adapt to living in the United States and to deal with her two children, who are in school and starting to “do American things.” You should next:
Select one:
A.
ask the client to teach you about her culture.
B.
educate yourself about her culture.
C.
refer the client to a therapist of her own culture.
D.
treat the client conjointly with a therapist from the client’s culture.
Answer A is correct: None of the answers is necessarily wrong, but this is the best answer. The best source of information about an individual’s culture is generally the individual himself or herself. In addition, asking the client about her culture might open up an important channel of communication between you and the client.
The correct answer is: ask the client to teach you about her culture.
A boy you have been seeing for six sessions in play therapy begins to dump toys on the floor and throw things around the room. This is an indication that:
Select one:
A.
play therapy is not working.
B.
behavioral techniques may be more effective.
C.
underlying feelings are beginning to surface for the boy.
D.
the boy is feeling threatened for some reason.
Answer C is correct: Although this question does not provide enough information for you to determine conclusively what’s happening with this boy, you’re given enough information to pick this as “best” answer. Play therapy can be very effective at uncovering repressed emotions, and children often “act out” their emotionality, as this boy is doing.
Answer A is incorrect: This is not the best answer because, given the boy’s reactions, it appears that play therapy is working.
Answer B is incorrect: Behavioral therapy would be more effective only if you are assuming that the goal of therapy is to make the boy behave better. Be careful not to assume things when choosing answers to questions.
Answer D is incorrect: This is not the best answer since the boy’s repressed emotions may or may not be related to feeling threatened.
After five sessions of therapy with a family, you all agree that things are even worse than when the family started therapy. The parents complain that there is continual discord at home: The children keep trying to get each other in trouble, the parents are always arguing, and there is never any laughter at the dinner table. When the family comes to their sixth session, the parents announce that they have decided to terminate therapy. You should:
Select one:
A.
suggest that you see all family members individually.
B.
reframe the escalation of symptoms as a learning opportunity.
C.
tell them that change is often a long and difficult process.
D.
allow them to terminate and provide them with referrals.
Answer B is correct: From a systems perspective, a system that is changing often experiences increased stress because its homeostasis has been disrupted. In other words, things often get worse before they get better. In this case, the therapist should introduce the idea that change and stress can be positive learning experiences and are not, in themselves, signs that therapy is not working.
Answer A is incorrect: This family may be working something out. Therefore, separating them at this point is contraindicated.
Answer C is incorrect: This may be true but would be less useful than reframing the escalation of symptoms.
Answer D is incorrect: This is playing into the family’s resistance to change.
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
Answer C is correct: 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.
The correct answer is: Gestalt therapy
Although it is important to avoid stereotypes when providing services to members of ethnic and racial minority groups, some generalizations are often made. For example, when working with Hispanic or Latino American clients, it is important to keep in mind all of the following EXCEPT:
Select one:
A.
different levels of acculturation among Hispanic or Latino family members can influence their perceptions of and responses to therapy.
B.
family therapy is often contraindicated, at least initially, because of the hierarchical nature of Hispanic or Latino families.
C.
behavioral and other active, problem-oriented approaches are usually more acceptable than insight-oriented approaches.
D.
sex-roles tend to be demarcated clearly and are relatively rigid.
Answer B is correct: Although Hispanic or Latino American families tend to be hierarchical, this does not preclude them from family therapy. In fact, family therapy is often the treatment-of-choice because of the close relationships between family members.
Answer A is incorrect: This is true. There are often different levels of acculturation not only between families but also within families (i.e., younger members of the family tend to be more acculturated to White middle-class values, beliefs, etc.).
Answer C is incorrect: This is true not only for Hispanic or Latino clients but also members of a number of other minority groups.
Answer D is incorrect: This is also generally true.
You are seeing a client named Bethany, who has a diagnosis of Bipolar I Disorder. She says she stopped taking her medication three days ago because her prescription ran out and she doesn’t have any money and because the drug makes her feel “like a zombie.” In the past, she has gone off her medication several times, sometimes with disastrous results. You are concerned about her because she has been stable for a while and has even started a part-time job. You:
Select one:
A.
tell her she cannot continue therapy with you until she goes back on medication.
B.
call her prescribing psychiatrist while she is present in the room after getting her permission to do so.
C.
ask her what she thinks will happen if she doesn’t start taking her medication again.
D.
tell her to make an appointment with her family physician.
Answer B is correct: The prescribing psychiatrist would be the person to speak to about his or her patient’s actions. By phoning the psychiatrist in the client’s presence, both you and your client would be able to hear the advice given by the psychiatrist regarding her medication. This may also increase the client’s compliance.
Answer A is incorrect: This is clearly inappropriate and possibly dangerous. Since the client’s medication is at issue, you must involve a medical professional.
Answer C is incorrect: This could be helpful, but it is not the best answer since it would probably not be sufficient to motivate her to start taking the drug again. In addition, the psychiatrist should be informed about her discontinuance and should make decisions about managing her medication.
Answer D is incorrect: This is not as good a choice as answer B since managing psychotropic drugs is best handled by the prescribing psychiatrist.
A treatment plan developed by a practitioner of rational emotive behavioral therapy (REBT) will focus on which of the following?
Select one:
A.
uncovering cognitive distortions
B.
identifying negative self-statements
C.
identifying activating events that lead to irrational beliefs
D.
identifying naturally occurring sources of positive reinforcement
Answer C is correct: To identify the correct answer to this question, you needed to recall that Ellis’s ABC model views maladaptive emotions and behaviors (C) to be the result of irrational beliefs (B) about activating events (A). In other words, irrational thinking about certain events (rather than the events themselves) are the source of maladaptive feelings and behaviors. Consequently, a goal of REBT is to identify the activating events and irrational beliefs about those events that lead to undesirable behaviors and then challenge and replace the irrational beliefs.
Answer A is incorrect: The term “cognitive distortions” is associated more with Beck’s cognitive-behavioral therapy than with Ellis’s rational emotive behavioral therapy.
Answer B is incorrect: Although negative self-statements are a target of most cognitive and cognitive-behavioral therapies, this answer is less precise than answer C and, therefore, is not the best answer.
Answer D is incorrect: This sounds more like the goal of behavioral therapies that focus on increasing or decreasing behaviors by altering the consequences of those behaviors.
An MFT’s new clients are a husband and wife who have been married for 30 years and raised two children. They report that the children are successful and that their oldest daughter has just given birth to their first grandchild. The husband learned two months ago that he has cancer, and the doctors have said his prognosis is uncertain. The couple has been struggling since getting this news: The wife has been anxious and weepy and is having difficultly sleeping at night. The husband has withdrawn from his wife, the kids, and his friends and has been having difficulty concentrating at work. What should be the immediate short-term objective(s) of therapy with these clients?
Select one:
A.
Provide support and perform suicide assessments on both of them.
B.
Acknowledge that these symptoms have emerged because the family is in crisis and that the crisis may have brought some unresolved issues to the surface.
C.
Assist the couple to cope with their grief and help them develop new patterns of communication.
D.
Explain that their symptoms are due to the stress of coping with the husband’s diagnosis, provide crisis intervention, and refer the couple to support groups for cancer patients and their families.
Answer D is correct: This question asks for the immediate treatment objective(s), and this is the best answer because it is most comprehensive and includes interventions targeting the diverse needs of these clients. Assessing suicide potential (answer A) may be appropriate, but it not sufficient. While it is true that individuals and families often have underlying issues that are exacerbated during a crisis, pointing this out to the couple would not help them get through this difficult period (answer B). Helping the couple cope with their current grief (answer C) is also important, but it is not sufficient.
During your first session with a middle-aged man, he tells you that his wife has suddenly become passive and withdrawn, that she is sleeping more than usual, and that she has become disinterested in sex. They have been married for 9 years, and “things have generally been good,” he says. He tells you he would like to bring his wife in for an evaluation but wanted to talk to you about it first because he is concerned that she might be embarrassed to have him tell you what his concerns are in front of her. Your FIRST intervention in this situation should be:
Select one:
A.
ask the man to bring his wife to the next therapy session.
B.
call the wife and suggest that she come for individual treatment.
C.
continue treating the man and attempt to identify and address his role in his wife’s symptoms.
D.
suggest that the man tell his wife to have a physical examination.
Answer D is correct: More than one of these interventions may be appropriate at some time, but the question asks about your first intervention, which can be interpreted to mean “most important” or “immediate.” Ruling out (and, as necessary, addressing) physiological factors underlying the woman’s symptoms is the most important first step.
Answer A is incorrect: Although conjoint therapy may be indicated later, you should first recommend that the wife get a physical exam.
Answer B is incorrect: This answer can be eliminated because calling the wife would violate your client’s confidentiality.
Answer C is incorrect: You would want to rule out the possibility of a medical explanation for the woman’s symptoms before assuming that the husband is causing or contributing to them.
You have been seeing a family of four because the mother discovered the 15-year-old daughter has been binge eating and purging. The 10-year-old son has some behavioral problems, but they have not yet been addressed in family sessions. After a month of family therapy, the daughter is still being identified as the problem by the mother and father. In the fifth session, the mother and father say they have been quarreling a lot lately. As a family systems therapist, you will:
Select one:
A.
ask each family member about the quarrelling
B.
have a few sessions with Mom and Dad only.
C.
send the daughter to a support group.
D.
have a few sessions with the daughter only.
Answer A is correct: This is the only answer that addresses the family issues systemically. Systems therapists are interested in how the system is supporting a problem rather than viewing one or two individuals as the source of the problem. Consequently, the first step for a systems therapist is to gather information from all family members.
Answer B is incorrect: Although this is a typical intervention for a Bowenian, it is not typical for a general systems therapist. Most systems therapists would not meet with the parents separately since this would identify them as the “problem” (“symptom bearers”) for the family.
Answer C is incorrect: This may eventually be a useful referral but, early in therapy, it would only identify the daughter as the source of the problem.
Answer D is incorrect: This would also perpetuate the daughter’s role as the identified patient.
A therapist is seeing a mother, father, and two children, ages 8 and 10, for issues related to the parents’ impending divorce. The parents have separated but there is no custody agreement yet. One reason for the divorce is the father’s drinking. The wife describes him as an alcoholic and says he may see the children while they’re separated, but not if he is drinking. During the current session, she tells the children that, if they see Dad drinking while they’re visiting, they are to call her and she will come and pick them up. The husband denies having an alcohol problem and asks the therapist to tell his wife that she is being unreasonable. What should the therapist do?
Select one:
A.
Speak to the father without the children present, letting him know that being intoxicated around the children is dangerous and that you will have to report him for child abuse.
B.
Speak to the parents without the children present and refuse to take sides in the argument about what is “reasonable,” but encourage them to see their lawyers to formalize a visitation arrangement that protects the children.
C.
With the entire family present, provide some information about alcoholism as a disease that affects everyone; focus on the mother’s co-dependency as well as the father’s dependency and encourage both parents to get into treatment; and develop a plan with the children regarding who they should call if they are frightened or uncomfortable around their father.
D.
Interview the children alone to determine the level of danger since neither the mother nor father is likely to be a reliable informant; interview the parents together to help them separate their conflict as a couple from their job as parents; and, in the parental interview.
Answer C is correct: This answer is the best one since it approaches the father’s alcohol problem in a systemic and non-judgmental way, although the husband’s denial that he even has a problem is probably going to make the “lecture” less than optimally effective.
Answer A is incorrect: This answer is incorrect since being drunk around the children does not, in itself, mean that the father is neglecting or endangering them to the point of child abuse. Also, drinking around the children has apparently not even happened yet.
Answer B is incorrect: This answer is incorrect because it just passes the assessment problem on to the lawyer, who is no doubt less equipped than the therapist to deal with it.
Answer D is incorrect: This asks the children to do even more of the inappropriate adult task their mother has given them – i.e., checking up on Dad and deciding if he’s been drinking.
