Exam 1 Flashcards

1
Q

Frequently SLPs help people deal with the ______ or ______ that surround a communication disorder.

A

a) FEELINGS

b) EMOTIONS

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2
Q

Define psychotherapy

A

Treatment of psychological abnormality – specialized training

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3
Q

Define counseling

A

Personal adjustment to difficult circumstances.

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4
Q

Define guidance

A

Advice and information given (less formal than counseling)

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5
Q

Who created the psychodynamic theory?

A

Freud

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6
Q

What is the psychodynamic theory based on?

A

Based on the psychoanalytic theory

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7
Q

What theory states that behavior is the product of conflicts between the id ego and superego?

A

Psychodynamic theory (Freud)

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8
Q

In which theory are there five psychosexual stages?

A

Psychodynamic theory – Freud

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9
Q

Who created the client centered theory?

A

Carl Rogers

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10
Q

What is the foundation of the client centered theory?

A

There is an EMPATHIC RELATIONSHIP between the client and therapist that will allow the client to freely experience and express all of his or her EMOTIONS in a completely ACCEPTING climate.

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11
Q

Which theory says that the SLP needs to be fully present in order for the client’s self-actualizing drive to bubble up and for them to actively choose to make changes?

A

Client centered theory Carl Rogers

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12
Q

What is step one of the client centered theory?

A

The client is encouraged to freely express his or her emotions.

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13
Q

What is step two of the client centered theory?

A

The clinician LISTENS and responds to content and feelings

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14
Q

What is step three of the client centered theory?

A

Accepting relationship with the clinician helped the client become open to change and growth

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15
Q

What is step four of the client centered theory?

A

Client takes responsibility for taking action towards goals she or he develops

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16
Q

What did DiLollo and Niemeyer (2014) say about empathic reflections about client’s feelings?

A

This technique…

takes little time in treatment sessions

earns clients trust and cooperation

sets the stage for joint problem-solving.

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17
Q

Saying “You’re really bored right now aren’t you? I’m pretty boring!” Is an example of what?

A

Empathic reflections

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18
Q

True or false: some multicultural clients may not like empathic reflections.

A

True

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19
Q

True or false: the more educated the client, the more they will want the list of action steps.

A

True

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20
Q

Robinson 2014, states that one theory is most helpful in the beginning, especially with a new diagnosis. Which theory is he referencing?

A

Client centered theory

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21
Q

Which theory looks at measurement, with an emphasis on OBSERVABLE behaviors, environmental, and external influences?

A

The behavioral theory

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22
Q

What theory says that all behavior is caused by environmental stimuli?

A

The behavioral theory

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23
Q

Which theory states that human behavior is the product of external reinforcement?

A

The behavioral theory

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24
Q

Which theory states that behavior is shaped and maintained by immediate consequences?

A

The behavioral theory

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25
Q

Which theory states that reinforcement must be given immediately after a particular behavior has occurred?

A

The behavioral theory

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26
Q

Which theory:

Engineering model of facilitating change

Goal set, task broken down into small steps

Careful reinforcement

A

Behavioral theory

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27
Q

Which theory does the clinician focus on specific outcomes rather than feelings?

A

The behaviorial theory

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28
Q

What is the goal of the behavioral theory?

A

To emphasize clients’ identifiable behaviors and make positive changes

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29
Q

Fruit loop therapy? (Which theory?)

A

The behavioral theory

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30
Q

When is the behavioral theory the most effective?

A

After a client centered approach, especially in the beginning where clients have strong emotions.

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31
Q

Which theory does not rely on having people get in touch with and express their feelings, and provides specific in practical steps for positive change? (Good for multicultural clients)

A

The behavioral theory/behavioral therapy

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32
Q

DiLollo and Neimeyer 2014:

What did they say about providing clinical services beyond simple teaching of behavioral techniques?

A

Behavioral methods are good for addressing surface issues, but not deeper emotional issues and psychological consequences of a communication disorder.

Behavioral methods alone often do not promote long-term meaningful change. Behavioral techniques are the tip of the iceberg.

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33
Q

True or false:

Robinson, 2014, stated that behavioral theory is ineffective at the beginning of a counseling relationship.

A

True

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34
Q

Which theory states that the client’s thoughts are key

A

Cognitive-behavioral theory

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35
Q

Which theory states that counseling is a three-step process?

A

Cognitive-behavioral theory

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36
Q

What are the three steps of the cognitive-behavioral theory?

A
  1. Change client’s thinking
  2. Change belief system
  3. Change behavior
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37
Q

Fill in the blank:

Luterman states that SLPs are only concerned with the _______ a client attaches to an event (not past history)

A

Meaning

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38
Q

Which approach is a highly confrontational approach in which the client is challenged to examine the underlying “irrational” assumptions reflected in his language or behavior? (Luterman)

A

Cognitive-behavioral theory

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39
Q

What are the stepping stones to learning?

A

Mistakes

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40
Q

True or false:

A cognitive therapist is not interested in emotions. They assume that how you think is how you feel and their interest is in changing thoughts.

A

True

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41
Q

What are the four things a cognitive therapist tries to do?

A
  1. Help client explore thinking
  2. Challenge client to test validity of their beliefs through experimentation
  3. Create change in thinking through analyzing the gathered data
  4. Create change in behavior based on the new, positive evidence
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42
Q

Which theory challenges clients to explore discrepancies between their thoughts and reality?

A

Cognitive-behavioral theory

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43
Q

What is one limitation of the cognitive-behavioral theory?

A

It may cut short the expression of strong emotions that need to come out.

(It is good for adults who have such a negative beliefs that treatment progress is impeded)

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44
Q

Which type of therapy is a branch of the cognitive-behavioral theory?

A

Reality therapy

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45
Q

Which therapy did psychiatrist William Glasser come up with?

A

Reality therapy

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46
Q

Which therapy focuses on the rational, logical, and language oriented?

A

Reality therapy

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47
Q

Which approach/therapy helps people take more effective control of their lives?

A

Reality therapy

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48
Q

In which therapy does the SLP confront inconsistencies openly and directly?

A

Reality therapy

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49
Q

What are the eight steps of reality therapy?

A
  1. Make friends with clients and ask what they want.
  2. Ask clients what they are choosing to do to get it.
  3. Ask if their behavioral choice is working for them.
  4. If it is not, help them make better choices (and create a written list)
  5. Get commitment from client to follow the better choices
  6. Do not accept excuses for failure to carry out plan – if not working, change it!
  7. Do not punish clients, but ask them to accept reasonable consequences for their behavior.
  8. Do not give up!
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50
Q

What are the three steps to an eclectic approach?

A
  1. Accept and listen to client nonjudgmentally and let them express their emotions.
  2. If feeling that are accompanied by negative thoughts are preventing progress, help the client test experimentally the validity of those thoughts.
  3. Help clients implement constructive behaviors to deal with the communication disorder.
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51
Q

What is the key to change?

A

Assuming responsibility

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52
Q

What are five cognitive distortions that clients have?

A

All or nothing thinking

Overgeneralization

Mental filter (dwelling on negatives)

Jumping to conclusions or “mind reading”

Emotional reasoning

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53
Q

What is emotional reasoning?

A

Taking ones emotions as evidence of truth; “I am sad, therefore you did something to cause me to feel this way.”

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54
Q

What type of statements make us feel pressured, resentful, and unmotivated?

A

“Should” statements

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55
Q

What is catastrophizing?

A

Thinking about the worst thing that can happen and believing it will happen to you.

“If my child is retained in 4th grade, he’ll become a behavior problem and maybe eventually turn to a life of crime.”

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56
Q

What are five mindsets that inspire procrastination?

A

Helplessness – factors beyond our control

Feeling overwhelmed

Perfectionism

Fear of failure/disapproval/criticism

Low frustration tolerance

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57
Q

Fill in the blank: many Americans have __________________.

A

Low frustration tolerance

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58
Q

What is one technique for when people cannot come to a conclusion or agree upon a course of action?

A
  1. First present a solution that’s really unpalatable.

E.g., “We could enroll meal for stuttering therapy and just let them go. Of course, the danger is, that when he gets to junior high, the other kids might really make fun of him and ostracize him.”

  1. Present another and palatable extreme.

E.g., “I could see Neil daily for 20-30 minutes sessions but he would always miss social studies and probably fall behind.”

  1. Present a “middle of the road” option that is very palatable.

E.g., “A third option is that I could see Neil twice a week for 20 minutes, and send home brief assignments for you to do with him. In this way, he wouldn’t miss too much class and we could work on strategies for him to be more fluent, especially if he goes into junior high. Which one of these sounds best to you?”

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59
Q

When having a meeting with a parent what do you begin with?

A

A general orientation.

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60
Q

How should you begin your meeting with a parent? (What kind of statement)

A

A positive statement

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61
Q

If people are really anxious and tense in a meeting what should you do?

A

Give them the bottom line about your diagnosis immediately and then give them more specific details about the testing later.

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62
Q

During a meeting, if people are more relaxed what should you do?

A

Present detailed findings first and build gradually to the conclusion. This is especially good for people who don’t believe there is a problem.

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63
Q

When closing the interview there are three things you should do. What are they?

A

Summarize the main points.

Repeat conclusions.

Give specific suggestions/recommendations.

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64
Q

If you want to make sure people understood what you said, what should you do?

A

You should ask them to explain how they will tell their spouse about what you said, and if they get it wrong, blame yourself and restate it for them. You can also put it in writing.

65
Q

What is one specific technique for effective communication with a parent? (Specifically to help with anger)

A

Sandwich negative and positive points… for example:

“Justin is so sweet and well behaved. Listening and focusing are definitely very challenging. But, with his good attitude and your support, we will make good progress.”

66
Q

If someone refuses to accept the diagnosis, what should you do?

A

Keep the door open and invite them to come back in the future if they ever need anything. Give them your business card and telling them to call you or email you if they ever need to in the future.

67
Q

What should you do if someone starts to cry?

A

Give them a Kleenex, touch them on the arm, and say “it’s OK to cry. This is difficult news.”

68
Q

What else should you do if someone starts to cry?

A

Stress to parents that they need to care for themselves, and supplement verbal communication with notes, visual materials, and Internet resources.

69
Q

What should you say if the child is not eligible for services?

A

“Even though your child was found not to be eligible for this service, we know that you wanted additional information and resources. We prepare this packet for you.”

70
Q

When interviewing, what are some general suggestions for the talkative client?

A
  1. Before hand, learn as much as possible about the person.
  2. In the beginning of the interview, make clear how much time there is for the session.
  3. Use interviews to confirm information.
71
Q

According to Haynes and Pindzola (2012), what are response antecedents?

A

Things that a person said earlier, comparing it to what they said just now.

72
Q

What is this an example of: “when you mentioned that Joey stutters more on the playground, it reminded me that you talked about his sister teasing him at home. Can you tell me more about this situation?”

A

Response antecedent

73
Q

What is the psychology of email?

A

The more prompt your reply, the more likely the person is to send you more emails. Let 1-2 days laps before you answer.

74
Q

Short silences of how many seconds are helpful because people are given time to think?

A

Five seconds or less. This gives people time to think and encourages them to say more.

75
Q

What are Gugles?

A

Behaviors that are less powerful and less offensive than overt interruptions but still act to interrupt or redirect conversation.

76
Q

Shuffling papers, picking up your pencil, clearing your throat, pushing your chair back, getting your materials together, and looking at your watch are examples of…

A

Gugles

77
Q

What do orientations at the beginning of the interview help with?

A

They state what the interview is about, and if digressions occur they help get the meeting back on track.

78
Q

What type of clients or parents do encouragers work for?

A

Quiet parents or clients

79
Q

What are encouragers?

A

Social reinforcers that help people to say more. For example, asking questions, smiling, and nodding your head.

80
Q

What are interpretations?

A

Verbalizations that describe why behaviors, events, or feelings have occurred. The goal is to provide a new perspective for a client. But you need to be careful because people can get mad.

For example “it would be very natural to be depressed when the baby is always sick, your husband is gone a lot, and you feel so alone. I’m wondering too if the idea of braces for Oscar right now feels really overwhelming given everything else that you’re dealing with.”

81
Q

What are some nonverbal behaviors to use during interviews?

A

Touch, facial expressions, I contact, head nodding, and body posture and leaning.

82
Q

Rosslyn Delmonico (8/10/2015):

60% of communication is body language. 30% is our voice (tone).

What percentage of communication are our words?

A

10% are words. (60, 30, 10)

83
Q

In an interview, summaries are for…

A

Highlighting in reviewing major points at the end of the session.

They are very useful for keeping things moving.

84
Q

In an interview, reflections…

A

Repeat a portion of the clients previous utterance.

Be careful because they are irritating if there overused.

85
Q

In an interview confrontations…

A

Enable clients to deal with realities that they might avoid or deny.

86
Q

In an interview what purpose does self-disclosure serve?

A

They help people feel understood. However, keep them brief.

87
Q

“I know how hard it is to feel loved older family member with dementia. I remember when my grandma had Alzheimer’s – it was so sad to see her deteriorate.”

This is an example of ____________.

A

Self Disclosure

88
Q

Because people only remember 25% of what you say, ______ are useful.

A

Repetitions

89
Q

What is the principle of scarcity?

A

Opportunities seem more valuable when supply is limited.

Hint: schedule at odd times to make your time see more valuable.

90
Q

What is social validation?

A

When people decide what to do based on what others think or are doing. We should use it.

91
Q

What is one reason that people get angry?

A

Fear

92
Q

What is fear?

A

People think they’re being treated unfairly and there’s a sense of injustice.

Profound loss, a sense of entitlement.

93
Q

What is entitlement?

A

When people think that if they work hard and are good people everything will be OK. And all their needs will be met.

94
Q

Often, what does a communication disorder result in for another member of the family? (usually the wife, mother, or sometimes older sister)

A

A loss of personal freedom

95
Q

Regarding power, what does anger result in?

A

Having no power to change things or not being able to make a situation better.

96
Q

According to David Burns of Stanford, when people get mad at us, what three reactions can we have?

A

Mad, sad, glad.

97
Q

If we get mad we get…

A

Defensive and argue with people. This is very human, and we tried to justify ourselves.

98
Q

If we get sad…

A

We concluded that the other person is right – we must’ve done something wrong. We may get depressed and withdraw and try to avoid the situation.

99
Q

If we are glad…

A

We acknowledge that there might be a grain of truth. We become investigative, and ask questions.

100
Q

What is the 4-pronged technique for disarming an angry person (CDEF)?

A

Complement person on something they did right.

Disarm them by finding something to agree with.

Encourage people to talk openly about why they’re angry.

Feedback and negotiation.

101
Q

What is the 4 pronged technique?

A

Complement, disarm, encourage open talk, feedback and negotiation.

102
Q

When people think “I’ve done something I shouldn’t have, this is all my fault.” This is an example of…

A

Guilt

103
Q

When people think “I failed to do something I should have,” this is an example of…

A

Personalization: people inappropriately assume responsibility for something they did not cause.

104
Q

When people feel confused and vulnerable from uncertainty, this is an example of…

A

Anxiety

105
Q

People are anxious, what can you do?

A

What you can do for the _______ person: Present things to read, and repeat information.

106
Q

What is disillusionment?

A

When we expect our life to go a certain way and when it doesn’t, we don’t deal with it well.

107
Q

What is a common reaction upon initial diagnosis of a communication disorder? (when the client or family thinks: “no that’s not possible!”)

A

Shock and disbelief – The family will often seek out multiple opinions.

108
Q

What is the defense mechanism, rationalization?

A

A defense mechanism in which an individual develops a logical but untrue explanation of an attitude or behavior.

109
Q

What is the defense mechanism, displacement?

A

A defense mechanism in which one transfers hostile feelings from the person or problem that caused the feelings onto another innocent person or object.

110
Q

What is the defense mechanism, projection?

A

A defense mechanism in which the person shifts responsibility to someone else; feelings or motives that belong to them are attributed to another person.

111
Q

What is the defense mechanism, reaction formation?

A

The defense mechanism in which people experience emotions that are so shocking or contrary to their previous thoughts/believes, that the new feelings are considered unacceptable and inappropriate. They then develop “positive” attitudes and outlooks that are opposed to their new, shocking, real internal feelings about the situation.

112
Q

What percentage do people remember of what you say?

A

25%

113
Q

What are Primary questions?

A

these questions introduce new topics or new areas within a topic

114
Q

what are Secondary questions?

A

these questions follow up and ask for more detail.

115
Q

what are closed questions?

A

highly structured (yes/no), such as “How old was Benny when he began to talk?” or “Is Jenny frustrated by her speech?”

116
Q

What are open questions?

A

these questions allow a lot of latitude, draw a client out, and encourage answers that may be more accurate. However, they can be time consuming.

117
Q

According to the American Counseling Association (2015), you can avoid burnout by…

A

Knowing your strengths and weaknesses and playing to them.

Bringing variety into your work.

Knowing what time of day you’re freshest.

Taking breaks to go outside –even 2 minutes!

Exercise –even walking

Colleagues to let off steam with (your fam gets tired of heraing it!)

keeping a small journal

taking time for fun & recreation

Remembering you don’t always have to fix things or provide a solution

SLEEP :)

having alone time

making your physical environment as nice as possible

getting professional help yourself if you need it.

118
Q

With religion, what should you remember?

A

some religious groups may not believe in intervention or rehab; some clients may seek/prefer alternative forms of healing.

119
Q

What are some differences between women and men in regards to their communication?

A

women. ..
- apologize more than men (look weak)

  • take up less space (appear restricted, powerless, & unconfident)
  • smile and nod more than men (makes you appear weak and like we’re trying too hard to please, or like we need approval)
  • use more boosters than men (i’m really happy to see you)
  • soften their speech with hedgers–e.g., “perhaps, somewhat, possibly” (appears uncertain)
  • use disclaimers, “I could be wrong here, but….”; “I hate to be a bother, but…”; “This may sound silly, but…” (men who use disclaimers appear more sensitive, and women appear weak. :/)
  • feel they need to give the gift of listening; men feel they need to give the gift of information.
  • see themselves as facilitators of conversation
  • end utterances with upward inflections and tag questions (appear uncertain and unintelligent)
  • use feeling words “I feel, I think, I believe that…”
  • tend to face their conversational partners and give verbal and nonverbal feedback.
120
Q

Some things men do that women don’t…

A

men. ..
- may be reluctant to seek and accept information

  • enjoy confrontation where there is a winner and loser.
  • use language for competition; women use language for rapport

–men often look around the room and don’t face their partners, and make fleeting eye contact.

121
Q

True or false: people are more likely to interrupt a man than a woman.

A

False. more likely to interrupt a woman than a man.

122
Q

in male-female conversations ___% of woman-initiated topics became the focus of conversation; ___% of male-initiated topics are sustained.

A

36% of women initiated topics

96% of male-introduced topics are sustained.

123
Q

Haynes & Pindzola (2012) stated that older clients…

A
  • may have more difficulty focusing on a task
  • have possible short-term memory problems
  • we may need to patiently explain things in detail several times.
124
Q

Family members of older clients who have neurological disorders may want to talk about…

A

…what their family member was like before.

125
Q

Haynes & Pindzola (2012) state that since many older clients tend to feel useless and discarded in our youth-oriented culture, and resentful that their bodies are betraying them, we should…

A

…listen to their memories of past achievements.

126
Q

Dark et. al (2011) stated that in old age, multiple, gradual, and cumulative losses occcur so frequently that there may be…

A

…insufficient time to grieve each one. :(

127
Q

Dark et. al (2011) stated that many older people have 5 things we need to keep in mind:

A
  1. limited support systems
  2. poor health
  3. decreased mobility
  4. decreased financial resources
  5. isolation
128
Q

Dark et. al (2011) stated that older people with lifelong disability deal with… (three things)

A
  1. changing caregivers
  2. loss of physical functioning
  3. loss of role fulfillment (being a spouce, valued family member, etc…)
129
Q

Dark et al (2011) said that for older people with lifelong disabilities, these three things helped:

A
  1. Communicating with an empathetic listener
  2. Time and opportunity to discuss the loss and to be involved in socially acceptable rituals of grieving
  3. having access to appropriate means of communication (AAC)
130
Q

What should you keep in mind about CLD clients regarding emotion?

A

Many CLD clients don’t expect to show emotion in front of you, and they want specific strategies. Some CLD adults will have experienced racism.

131
Q

What do Haynes & Pindzola (2012) state about interviewing CLD clients?

A

that many cultures find it difficult to reveal personal info; you may need to conduct multiple interviews and establish strong relationships with clients.

132
Q

When influencing clients, what should you remember?

A
  • “because” is a real influence on people
  • use evidence of past successes
  • use the “foot in the door” technique: get them to agree to a small commitment so it’s easier to carry out a larger request later.
  • get the person saying “yes” right away***
  • let other people feel that ideas are theirs.
  • make them feel important.
133
Q

What color paint is best for your office?

A

Green! People don’t think they’ve been there as long.

Yellow and orange are the worst because they make people feel rushed and want to hurry up

134
Q

What does the Principle of Scarcity say?

A

Opportunities seem more valuable when supply is limited.

135
Q

What is the defense mechanism, suppression?

A

The defense mechanism in which individuals keep their impulses, wishes, and desires under control and hidden from others.

136
Q

What is the defense mechanism, repression?

A

A defense mechanism like suppression, but the person is not conscious of their emotions or feelings. Individual suppress their impulses, wishes, and desires to such an extent that they no longer consciously recognize their true feelings.

137
Q

What is empathy?

A

When you enter into and share the feelings of others.

138
Q

What are the two kinds of empathy?

A

Primary empathy: communication of our ____ of the client’s message.

Advanced empathy: includes self-disclosure

139
Q

According to Shames 2000:

Sharing behavior is not designed to relieve the tension’s or meet the problem needs of the counselor. What should it NOT result in?

A

It should not result in a prolonged or specific focus on the counselor by either the counselor or the client.

140
Q

According to the social justice perspective, we have a… (_____ responsibility to…)

A

… Social responsibility to work for more equitable distribution of resources, rights, and opportunities for all people.

141
Q

According to Berry (2009), what was the view of disabilities from the 1900s to the 1950s?

A

Exclude and segregate; children are the responsibilities of families and parents are blamed and stigmatized.

142
Q

According to Berry (2009), what was the view of disabilities from the 1950s to 1980?

A

Identify and assist; families were still held mostly responsible and institutionalization was still common. There was increased federal funding and lawsuits were filed and won. IDEA was introduced in 1975.

143
Q

According to Berry (2009), what was the view of disabilities from 1980-present?

A

Include and empower;

Parents have more rights; students with disabilities began attending school with typically developing students; by the late 1980s, some states closed all institutions and replaced them with community services; then other states began doing this. Bush signed the Americans With Disabilities Act in 1990 and this prevented workplace discrimination against the disabled. Full inclusion- there was a formal movement

144
Q

What are three ways to understand others for establishing rapport?

A
  1. Secondhand (reports, talking to others)
  2. Our own frame of reference.
  3. Their personal frame of reference.
145
Q

What are some hindrances to rapport?

A

Allowing interruptions, showing shock, frowning/looking disapproving, fidgeting, poor eye contact, glancing at the clock.

146
Q

What are five ways to improve someone’s motivation?

A
  1. Frequency of contact between parties
  2. Reward for working towards treatment goals
  3. Shared effort and responsibility between clinician and client.
  4. Goals that the client thinks are important
  5. Have the client learned enough about their disorder to have a moderate level of anxiety about it
147
Q

What are the four types of listening?

A

Listening for comprehension, listening for empathy, listening for evaluation, and listening for resolution

148
Q

What is the goal of listening for comprehension?

A

To remain objective, and not make judgments or critically inspect information.

149
Q

What is the goal of listening for empathy?

A

To convey genuine concern, understanding, and involvement

150
Q

What is the goal of listening for evaluation?

A

To judge what we hear and observe.

151
Q

What is the goal of listening for resolution?

A

To solve the problem together as opposed to us solving it for the client. The focus is “us”

152
Q

According to the ASHA Leader (Margolis):

Patients retain about ___% of what we tell them. Of the ___% they retain, they will get 1/2 wrong.
**Thus, when we give info, people will accurately retain about __% of it.

A

50%

50%, 1/2

25% of what we tell them.

153
Q

What is the primary effect for helping people remember info?

A

Information presented first is usually remembered best

154
Q

What is the recency effect?

A

The last thing people here tends to be remembered.

155
Q

Regarding the primary and recency effect, when should the most important information be presented?

A

At both the beginning and the end of the session.

156
Q

ASHA Leader (Margolis)

Intelligence is not related to retention of information. However, _________ with the info was related.

A

familiarity

157
Q

List three factors that interfere with retention of information.

A

Old age, high anxiety, and denial of the situation.

158
Q

According to Berry (2009), what is critically important for parents of children with disabilities?

A

Connecting with other parents who are going through the same experience as they are.

159
Q

What are seven things that are outside our scope of practice according to Robinson, 2014?

A
  1. Chemical dependence
  2. Child/elder abuse
  3. Legal conflicts
  4. Marital problems
  5. Personality/character disorders
  6. Sexual abuse/sexual problems
  7. Suicide ideation