Example Questions Flashcards
Who is your first obligation to when it comes to risk - yourself, the client or the community?
FIRST obligation as a psych if anyone at risk in community - COMMUNITY is first obligation
If there is no community member involved who is your first obligation to in a situation of risk? Yourself or the client?
The client
When answering questions what is the best type of answer to choose?
When answering questions for the board in all areas - think about what is the most conservative and complete answer eg fax and call, email and call or always document information.
In multiple-choice questions what are the likely option and which ones would you not choose?
Minus one Plus one = 0 principle (2 equally wrong or right questions)
None is likely to be the right answer - 2 answers worded similarly
5 options - 2 answers that are equal they seem the same - are NOT the answer
Q;If you are rural and no-one there you may be able to see this client….in which conditions;
Would you a) get extra education b) see them and read everything and supervision c) will you tell them you don’t have experience but if they give consent seek SV and do training in area d) send back to GP and say we cant see them, tell them closest person is 300 km’s away
C)Consent to understand limitations - doing the best for client
In terms of competence why do we do CPD (continuous professional development) - a) it’s a requirement of the board b) it’s a requirement of Medicare c) we need to demonstrate we are scientist practitioners d) we need to maintain provision and quality of improvement of psychologist services e) or psych practice is continually peer reviewed?
Hints and clues - everything we do is based on the ethical code - why would you do it anyway - to deliver the best services to clients -
d) BEST answer is the “because it’s in the best interest of the client”
THAT”S why we do it +1 - 1 AHPRA and Medicare
Q. 17yr old at school disclosed they will bash someone who is part of a different ethnic background - he hasn’t participated
Keep conf and work with him b) do anger mgt c) talk to principal or d) police e) ring the parents
c) AT SCHOOLS INVOLVE THE PRINCIPAL - they are the boss at school
Do you advise the client? - no not if there is a risk to you or a safety risk to you
If exam asks what to do as a school psych; inform the principal
E.g. Nazi example of graffiti and singing - CALL PRINCIPAL - principal will call police and they will decide how to deal with it
Before involving child protection - involve the principal
E.g. drugs at school - need to inform the principal
Previous exam: if a case is discussed in peer supervision and client is de-identified do you still need to mention to the client
Do the most conservative
Document everything and be the most protective -ANSWER; yes- tell client and document in file
Don’t mention it at all
Include in consent form - if I consider it helpful your de-identified may be discussed in supervision
IN PRIVATE practice you don’t need to tell anyone - except for risk of harm
From exam
Q Husband of client calls and threatens to harm client - ringing and threatening, a) call police immediately b) calm client down and advise your client c) don’t worry about it d) politely as the client to call back later
FIRST THING INFORM THE POLICE TO PROTECT FROM THE THREAT
Police will talk to your client - all based on Tarrasof Case Uni of California was - no laws in Australia with the same issue - if someone threatens - ethical maintain confidentiality - legally let someone know POLICE in this case legal issue trump ethical
If violent or threatening people
What should you do if you come across an ethical dilemma and you don’t know what to do?
Always choose to talk to a supervisor to discuss options - use ethical decision-making model
From exam Q: There was a question where psych is in session with a client when clients husband comes in to the practice demanding to speak to see his wife (history of aggression towards wife). what do you do? do you ask him to wait; do you call the police; do you continue session with client?
If an AVO call Police - I can’t say yes or no - leave the practice - otherwise, I will have to call the Police because you are trespassing
RULE OF THUMB - Risk, threat AVO breaching AVO - call the Police (most protection for 1- client 2- yourself)
Q: You are seeing a person for a work cover issue - and relationship issues come up can you help them with their relationship as well?
YOU CAN NOT HELP THEM WITH THESE ISSUE WITH WORK COVER - once you finish you can help them (you can only do the work injury so far) come back and I could see you under Medicare or private health insure
A client has asked for a copy of his file. While I am happy to talk to him about my documentation, I do not want to give him a copy. Must I comply?
As a general rule, under legislation such as the Privacy Act’s Australian Privacy Principles (APPs), Freedom of Information (government sector) and Health Records Acts, clients have a right to access their personal information. The recent amendments to the APPs have also made it clearer that clients have a right to a copy of that information “in the manner requested by the individual, if it is reasonable and practicable to do so”. It is important, therefore, to always write your notes as if the client will have access to them.
There are some exceptions to providing access to client notes, which are associated with issues of risk, the impact on another person’s privacy, and legal matters. In addition, psychologists should not provide access to protected psychological test material or information that has been provided by a party other than the client (e.g., a family member who has provided additional information to the psychologist) unless this is under a legal request such as a warrant or subpoena.
I have conducted an assessment of a client and prepared a report that was commissioned and paid for by an accident compensation provider. The client has asked for a copy of her file. Does she have a right to have a copy?
As indicated in response to the above question, generally legislation supports clients’ right to access their personal information. In this case you should also check your contractual arrangement with the accident compensation provider. This may, for example, specify that you inform them of any requests for access. In most cases, even though the report was commissioned and paid for by a third party, the client’s right to access endures (with the normal exceptions).
I am working with a 10-year-old child with anxiety and her parents have challenged me about her rate of improvement, particularly now that her Medicare-funded sessions have been used up and their GP indicated that 10 sessions would suffice. How should I respond?
According to the APS Code of Ethics and Charter for clients of APS psychologists, psychologists are required to inform clients about the services they will receive, including an estimate of the number of sessions that might be required to meet their goals. In providing this information it is important to use language that does not provide a guaranteed outcome, although you might talk about a period of time in which improvement would be expected. In addition, clients should be informed that goals and treatment are reviewed regularly, which is an opportunity to provide additional information about progress.
If you have followed such a process when informing your client’s parents, then remind the parents of the information that you provided to them, identify progress that has occurred and discuss any recommendations you have for moving forward. Separate to discussions with the parents, it may be useful to have a tactful discussion with the referring GP about not pre-empting the outcomes of treatment.
QUESTION: E.g. a woman remembers being abused as a 3 year old what is the main thing to do
- Get consent to work with memory maybe EMDR
- Discuss with client properties of previously unreported memories
- Explore the meaning of the memory instead of the details
- She needs to find a way to prove the accuracy of this memory
- Talk to her about what will happen with this memory and what your role is there
You need to understand about memory and how it is fallible and there is no way to prove whether it happened or didn’t - you can not know with certainty what happened in the past
Find an answer where MEMORY IS FALLIBLE - you can not know with certainty
Q; What is one of the most important things to discuss with client’s Eg PTSD client - you decide to do EMDR with the client
A)Client obligations at least ten sessions and book ahead
B)Client making a commitment to change
C)How successful the treatment is in the community and how much success in the past
D)Any extra charges
E) Any negative outcomes which can be gained from EMDR
E) Any negative outcomes which can be gained from EMDR
Any time you go from initial assessment to targeted intervention - you need to talk about adverse effects - or discuss verbally and document
Similar to medical procedures
Think about this in more specific terms - the same for EMDR CBT, Exposure e.g. might increase anxiety for a while , NEED TO WARN THE CLIENT OF ADVERSE OUTCOMES
Q: What happens when you need to make complex decisions?
2 types of questions in the exam
1. Where you know the situation is pretty clear 13 year old abused by 25 year old - need to report; Ethics guideline says you can’t have sex with clients - is a definite no - need to report
- Maybe with peers ethical grey area; someone talking about seeing adolescent client and the Mum wants you to see another one of her children? What should you say? Are there any guidelines or laws that make it illegal to see two people from the same family - no legal rules there I NEED TO USE AN ETHICAL DECISION-MAKING MODEL
E.g. Organisation psychology with coco cola - sent to do something
The company charges $800 per hour for you
You realise there are needs in the company - that goes against the company you are working for
This company doesn’t need to see you 5 hours a day every day - or you are not appropriate
What do you do in this case?
A) Do you go with the needs of your organisation. Is. A plus one - minus one answer
B) Go with needs of coca-cola
C)Talk to senior colleagues about making an ethical decision
Choose an answer where you are going to use a decision assistance model
Peer supervision
Q: Once EAP finished they kept seeing the EAP client and they kept seeing you for other issues - the client is now paying for the sessions
What do you discuss??
A)Why is the client dependent?
B)Why are they having therapy?
C)Discuss having Medicare with this client?
D)Discuss ethical considerations of taking them on privately?
D)Discuss ethical considerations of taking them on privately?
EAP is not forever - is it ok if I continue seeing them, do I need to continue treatment- is this overservicing the client - does this client really need my support
Q. E.g. you get referred a client and then as you are talking to them they tell you he is a builder and her was getting free sessions from your colleague because she didn’t need any more renovations - he was hoping for free sessions for a renovation that you needed
What is the first thing you would do?
- Tell the client you can’t take him on you don’t need reno’s
- You would tell the client that you can not accept that arrangement and fee is $280 per session- if you get a MHCP you can get a rebate
- You tell the client you are concerned about this other psych exploiting him
- Not say anything and go ahead because you need renovations
- Discuss with colleague concerns about the builder and their ethical issues related to their arrangements / service delivery (risk of exploitation here)
- Discuss with colleague concerns about the builder and their ethical issues related to their arrangements / service delivery (risk of exploitation here)
Some answers will be report straight away
Q;What is a client you are seeing for a while and she invites you to her graduation - she says you have helped her and she really wants to invite you
A)Politely decline and explain why - you’d want to see pics or diploma’s
What if you see someone at a coffee shop and he invites you for a coffee to thank you - and you stay and he makes a business proposition
ALL NO NO NO NO - no coffee, no mental health appointment
E.g. 13 1/2 yr old bullied online, feel hopeless and some one they know is harming themselves and please don’t tell parents and they are worried they would make things worse -
What do you do?
A)Tell child you have to parents and explain
B)Encourage child to talk to school counsellor
C)Teach client strategies to deal with bullying
D)Talk to the school and report what’s happening
A)Tell child you have to parents and explain
Exam; If you had a client that you had been seeing under EAP for 12mths and the employer called and wants information
a) would you inform the client of request
b) not discuss with the employer directly
c) Talk to the client first ie company knows; work cover knows; insurance knows; GP knows -
c ) ANSWER is they should talk directly to the client
Note - usually with work cover the company/ins knows/ IF employer calls to ask how they would going you would always seek consent from the client first to talk with them
Q: If you are seeing a uni-student who tells you they are feeling down and their girlfriend just left them and there’s no point living;
Do an assessment and you realise that the risk is high for the client
What do you do in this case; you need to go to the hospital, shall I call and ambulance now - no I’m going to be ok Ill see you at some point - he wants to leave
a) Do nothing a and call in a couple of days
b) Tell him your going to take him to hospital and you tell him that you have your car there and you can take him now
c) Call the parents and let them know of the plan and the risk
d) Talk to a senior psych or management and discuss risk and plan
e) You tell him that he has to stay there and wait until the police and the ambulance come?
In this case because of so many variable neither of them is great - don’t take them to hospital no insurance - can you call parents? NO
Let manager know YES Talk to SENIOR PSYCHOLOGIST
If he leaves and you have concerns you would send a fax and call the mental health area
Acutely suicidal - try to keep them there - but you can’t force someone to stay there
If acute call 000
ALWAYS DO A RISK ASSESSMENT IF SOMEONE DISCLOSES SUICIDAL IDEATION
Q; If they have weapons at home what do you need to do?- he is very depressed
Do a safety plan and report to police
Do a risk assessment - if there is a risk of harm to themselves or others
If risk is moderate to high you would have to report them
THE BOARD IS MORE INTERESTED IN RISK ASSESSMENT - and if risk is severe report them
Based on that you then make a decision
ALWAYS DO A RISK ASSESSMENT FIRST
Q. Someone telling you are angry and they know about explosives and they are going to get revenge;
What do you do?
You need to report them and you have enough information and planning to hurt someone
You don’t need to tell the client you are reporting
THIS WAS IN THE LAST EXAM
Q; Nursing home - saying he doesn’t need to go and the older guy doesn’t have cognitive impairment -
a) Tell them he has no cog impairment and it’s not necessary
b) Report for Elder abuse
c) Another battery of tests to make sure
d) You ask them to come to therapy father and son - do r/ship counselling
e) Move to the Bahamas
a) Tell them he has no cog impairment and it’s not necessary
Remember you are not CSI - you don’t investigate these things, stay with the facts - don’t imagine, interpret or assume things -
Just sending him to nursing home is NOT evidence of elder abuse
Q: If a client wants to access their records what do you do?
a) Offer to give them a summary
b) Read records in office
c) Offer more treatment to figure out what’s going on now?
You don’t charge for their right to read their records
ANS: Invite to come in but they don’t have to come in to read their records
You don’t need to give them a copy - if its government you need to give them a copy
THIS SHOULD BE IN THE CONSENT FORM TO - how you give access to records
APS and AHPRA - should at least give a chance to come in and discuss their notes
If you said they have a right to a copy
You don’t give a copy without discussing it first
GIVE COPY only after discussing with client
Q: If you move to a practice - what do you do with your case notes?
What if you are told not to take the files with you due to restriction of trade?
What is the most important factor to consider in this case?
a) Policy and restriction of trade
b) Reputation of current practice
c) The clients right to files
d) Safety of client finishing early
e) The client best interests
e) The client’s best interests
NOT THE Principal consultants greed you can’t keep clients
Contracts saying you need to relinquish clients - you can’t do that - like a GP you can’t tell anyone where to go for services - they have a right to continue service
Contracts like that do not stand a chance in court
How long do client records needs to kept for adults
Minumum of 7 years since last client contact
How long do child records need to be kept
In the case of records collected while the client was less than 18 years old, psychologists retain the records at least until the client attains the age of 25 years (7 years after they turn 18)
Q: What happens when a client can not pay? You are half way through therapy treating client for mod-severe depression and they ring you and say they can’t continue as husband lost their job - what do you do in that case? They have see you for 5 sessions out of 10
a. You negotiate to continue at reduce cost b. Refer for a bulk bill psychologist c. You barter or something like that d. Make a contract and accept delayed payment e. You finish treatment and refer back to GP for referral for lower fees
WHAT IS THE BEST INTERST OF THE CLIENT? -
WHY CAN’T WE CHARGE LESS?
The gap is close to $100 - you get $150 - $160 per hour
YOUR OBLIGATION IS TO FINISH THIS TREATMENT - ITS WHAT AHPRA WANTS
Q; What if in supervision someone says they haven’t done PD
a) Tell them to make up the hours b) Call and tell psych board c) Tell them to forget it and no one will audit
Call and tell psych board
What can’t you do in advertising your psychology business
- be false, misleading or deceptive, or likely to be misleading or deceptive
- offer a gift, discount or other inducement, use testimonials or purported testimonials about the service or business
- create an unreasonable expectation of beneficial treatment
- directly or indirectly encourage the indiscriminate or unnecessary use of regulated health services.
You can not call yourself anything if you are not endorsed or registered in Australia
Q; you present a case at supervision with 3 other psychologists and you present a complex case for 30 mins and then the rest of the group discuss it for 30 mins - how do you count that?
a) Each member counts 30 mins peer supervision and 30 PD
b) Each member counts 1 hour peer supervision
c) Each member counts an hour of prof dev
d) You count an hour peer supervision and the other count 30 mins peer supervision
e) You count an hour peer supervsion and others 1hr PD
You count an hour peer supervsion and others 1hr PD
Peer supervision is counted on your own clients - other clients is not peer supervision
You need 1 hour per month focused on your work
The next hour of listening to your colleagues would be PD for you and peer supervision for you
How many hours of Professional Development are required per year?
30 hours total = 10 peer supervision and 20 other PD
How many hours of peer supervision per year is required?
10 (as a part of the 30 hours required)
What does CPD stand for?
Continuing Professional Development
Why do CDP?
THE MAIN REASON IS TO MAINTAIN THE HIGHEST LEVEL OF SERVICE TO DO THE BEST JOB FOR YOUR CLIENT
HOW MUCH CDP YOU NEED TO DO?
DO A PLAN
DECIDE HOW TO MEET THOSE GOALS
WRITE A REFLECTIVE JOURNAL ABOUT WHAT YOU HAVE DONE
END OF YEAR WRITE HOW THE CPD YOU’VE DONE HOW IT HAS INCREASED YOUR KNOWLEDGE AND ENHANCED YOUR PRACTICE
YOU NEED 30 HOURS OF CPD - doesn’t matter if you are part time
10 HOURS NEED TO BE PEER SUPERVISION
Q; What if client says they felt uncomfortable with another therpist - sexual dreams I was included; they invited me out - they say they are worried about - they want you to report?
What do you do?
a) Nothing you respect their privacy
b) You put investigator hat on
c) You report to AHPRA
d) You process the trauma with the client
e) Tell the client to report to the police
c)You report to AHPRA
Q What if peer supervision - they tell you they drink a lot to relax
a) Offer them a session to treat them
b) Make a notification
c) Suggest changing supervision to business hours
d) You contact the psy board the next day
e) You discuss strategies including see a professional
e) You discuss strategies including see a professional
Is it your job to investigate whether they are affected in the practice ? NO
EXAM
A NURSE who was not at work at the time - was brought into an Emergency Department in an ambulance as she had been in an accident and turns out she was driving under the influence. You are the assessing psychologist and the client (nurse) doesn’t believe that she has a drinking problem. what do you do? options were something like -
a) report to her employer
b) report to AHPRA
c) Recommend to see GP to further look into if there’s a drinking problem
d) cant remember the other 2 options as I ruled them out right away.
c) Recommend to see GP to further look into if there’s a drinking problem
If you don’t believe it is affecting their work - you don’t have to report it
If you have enough reason to see that work is influenced and then report
Q: One colleague has a brain tumor and in the meantime they are practicing and you are worried about their cognitive function
a) Discuss with colleague contingency plan
b) Talk to the insurance company about concerns
c) Discuss the plans that they have
d) Discuss the supports the psych needs to see their client
e) Notify to the PSYCH board
You need to notify if you have concerns about their cognitive abilities
She reported someone was using shamanic practices - if they are doing something really out there and they are causing issues for clients - or long therapy with little outcomes
Q: What about if you are seeing someone who tells you that they have chronic pain and the psych from before told them that they had to stop taking medication and they sold them some homeopathic medication?
What do you do?
Report to AHPRA
What if they recommended it but didn’t sell it - still report - it is not in your area of expertise? NO NO NO
Report to AHPRA
YOU MUST USE APPROVED TREATMENTS
Can people have case notes anonymous - YOU SAY NO - you need all of their details
IF YOU HAVE ENOUGH INFORMATION - REPORT
QUESTION: E.g. a woman remembers being abused as a 3 year old what is the main thing to do
- Get consent to work with memory maybe EMDR
- Discuss with client properties of previously unreported memories
- Explore the meaning of the memory instead of the details
- She needs to find a way to prove the accuracy of this memory
- Talk to her about what will happen with this memory and what your role is there
- Discuss with client properties of previously unreported memories
You need to understand about memory and how it is fallible and there is no way to prove whether it happened or didn’t - you can not know with certainty what happened in the past
Find an answer where MEMORY IS FALLIBLE - you can not know with certainty
Q:What if a child is tired halfway through a WISC and you can see they are tired and not focused?
1. Use what you have to make a score 2. Get the kids to have a break 3. Finish the subtest you are going 4. Cancel the whole thing 5. Do the whole thing starting again when the child is focused 6. Abandon the WISC and do another test because it is to long for the child ?
- Do the whole thing starting again when the child is focused (within the week)
You are asked to test a young man who is having difficulties learning at school and teachers are concerned about his progress - he is 16 and 11 months - which test would you choose to do with him
1. WISC because no OZ norm 2. WISC because the ceiling is lower 3. WISC because a person could have low intellectual functioning 4. WAIS because you have that available Here you are more concerned about the floor ….not the ceiling
- YOU WOULD CHOOSE THE WISC as CHILD IS SUSPECTED LOW FUNCTIONING
You would choose WAIS if high functioning 16yr old
What happens if you see a young man who is suspected of low intellectual functioning, struggling at school just turned 17 and you decide to administer the WISC- what is the explanations
1. You don't know anything about testing 2. You can use 16:11mths because it s close 3. WISC is easier and more suitable to ID 4. WISC because that’s the test you have
- If you don’t have norms for that age ….don’t use the test . - no one cares
The only time you can have an overlap. WISC 16:11 mths WAIS 16
Kids 17 and over always use the WAIS
(you can not use a WISC with a 17yr old) there are no norms …
Q you do a WISC with a 13yrs old and she gets FSIQ of 95 and she has scores from 65 in VCI and 123 in VSI - with all scores in between - scores are valid and reliable. - what is the most important first step when determining
a. Focus on FQIS being avg range b. Talk about clients weaknesses in processing speed c. Focus on the variability and range of index d. 4 Focus on superior comprehension Focus on the GAI -
a) focus on the FSIQ being average??? check
general index ability Useful ONLY WHEN VCI 65 -VSI 123 and Fluid reasoning 95 (is that representative of Cog abilities ) only useful when those scores are fairly similar and different to processing and verbal memory
9yo refugee family came to Australia 6 yrs ago - speaks English fluently and school is concerned about performance and they think he will have ID - you do they WISC and see that he scores avg in FSIQ and
What can you conclude about
a. Trauma has affected his performance
b. He needs a non verbal test
c. His difficulties are unlikely to be due to cog factors
d. You need to do a Stanford Binet
e. The school is assessing him in the wrong way
c. His difficulties are unlikely to be due to cog factors
WISC assesses cognitive factors
He may have difficulties with - maths or reading
He learned to speak english age of 2
We can’t say they are not teaching him write
Lets say the child 12 y/o gets a score of 110 in VSI and 78 in the Verbal Comprehension index - what would you say this result
a. That their fluid intelligence is superior than crystalised intelligence
b. That you can not compare the two scores sig difference
c. That their crystalised intelligence is superior to fluid intelligence
d. Assess with a different test
e. That fluid intelligence and crystalised intelligence are very similar
a. That their fluid intelligence is superior than their crystalised intelligence
You can still compare them - one is much higher and - you couldn’t get the AVERAGE - BUT YOU CAN COMPARE THE SCORES - we constantly compare score
QUESTION: You are testing a kid and you are doing block design and he does the correct design but he is 1.5 second late after the time has ended
a. Make a note and score as incorrect b. Tell him to hurry next time c. Make a note and d. Make note he was slow and make a note and add to next few items e. Check timing device - score as correct because it was withing the error range for your timer
a. Make a note and score as incorrect
What happens if a child rotates a the visual blocks at 30”
a. you correct it and move it to be straight and mark as correct
b. Tell him to make as straight and incorrect (only remind the first time)
c. Do nothing and mark as incorrect
d. Continue correcting design as many times as he does it - but only score as incorrect from the second time he rotates
b. Tell him to make as straight and mark incorrect (only remind the first time)
Seeing 9yr old, start with item 3 and they get it right in trial 2 of of item 3
Wrong in trial 1 and right in trial 2
What do you have to do in that case?
a. Do you continue with item 4 and 5 - b. Do you reverse to item 2 c. Do you administer trial 3 d. Do you stop the test because he cant do block design
REVERSE RULE FOR THE WISC
IF NOT A PERFECT SCORE ON THE FIRST 2 ITEMS YOU reverse score
check this answer
QUESTION You are assessing 12 yr old FSIQ of 75 and they have a VCI of 98 a VSI of 89 and FRI of 93 and a processing speed index of 58 and a working memory index of 62
Which is the best way to int
Use GAI and CPI Use FSIQ Say that child has mild ID Say that child prob has ADHD due to scores He needs to work in Bahamas
Use GAI and CPI
A child comes to you and they say the school says they have behavioral difficulties and they and FSQI is 138 and no sig differences
What would you say (hypothesis)- he is gifted and maybe bored
ODD
ADHD
Child needs a learning plan
What would you say (hypothesis)- he is gifted and maybe bored
Both WAIS-IV and WISC-5 are reported in standard scores
o MEAN 100
o SD 15
People who score 2 SD below mean = ID (<70)
People who score 2 SD above mean = Gifted (>129)
What happens if they are trying to match the sides and not the top?
Tell them to focus on the top????
Need answer (ask Jo)
How long should it take to do a WISC?
Higher functioning 1.5
( due to intelligence less skipped questions)
Lower functioning 1 (due to many skipped questions)
If you have gone way over the time
She normally gives a break after the first 5 subtests
Stop finish the subtest - and then re-schedule for another time - make apt to finish assessments best decision is to let him go and come back - remember the right answer should have a lot of detail - try to do within the same week - RIGHT ANSWER IS GRAMMATICALLY CORRECT
Finish subtest- come back within a week
QUESTION: You do a WAIS with a person who is applying for disability pension and they score 81 as a FSIQ and their Preasoning is 85 and their VC is 80 and PS is 60 Wmenm is 71
- He can apply for disability pension based on processing sppe
- He does not meet 2 sd below mean so can not apply
- A score of 81 is 2SD below mean so he can apply
- You need to do a non verbal test to see whether he can apply for DP
- You offer job in Bahamas café
He doesn’t meet criteria of 70 or below
Q: You do a WAIS and he gets FSIQ of 70 ? But he did ok at school - so you need to investigate further
What would you do ?
LOOK AT THE INDEX SCORES
FSQI then index scores look at the order of interpretation otherwise you don’t know what to test for further
You can’t make further explorations from there
If PR is high and something else is low you go from there
Find out more history
Someone is struggling as difficulties with daily activities and borderline IQ - which test would you use?
1. SDQ 2. PAI 3. ABAS 4. WAIS 5. WISC
- ABAS
Doing an assessment with 48yr old so you do all the 15 subtests - what is the main reason to use extra subtests?
a. Inc validity b. To increase Reliability c. To not have to do any other tests d. Generate different hypothesis e. To do comprehensive assessment of cog functioning (WAIS is already comprehensive with the ten)
d. to generate different hypothesis
Q; You have been referred someone for a psych assessment because they are being treated for an accident and they have a minor injury and the client is saying they have pain and can’t work - why would you be doing a PAI?
They board likes to trick you - into seeing a client who is referred by a Dr who had an accident and their rehab Dr is wondering about their psychological state and why are you doing the PAI
- to see whether the person is malingering;
- to make a comprehensive assessment of clients personality (it’s really psychopathological and personality) -
- to see whether the disability os valid;
- to give an objective assessment for the dr; or to
- formulate accurately the clients problems?
You can’t formulate the client’s problems from this scale? - You are not an investigator - no one has told you about malingering
They have been referred for a psych assessment - have you been asked to give an opinion of the neck injury??? NOOOOO stay with the question - you are doing it
TO ENSURE A COMPREHENSIVE ASSESSMENT OF THE CLIENT
DON’T ASSUME ITS FOR INSURANCE ….IF THEY DON”T SAY IT - maybe they are depressed or they have somatic symptoms that have a psychological impact
What happens if you are working for the Aust govt and you are trying to do the PAI for people who have applied to spend 2 years in the antarctic doing some research and you want to see which people are more suited to survive - what sort of norms would you use if screen on -
- The 2pt scales,
- Clinical scales only,
- Look at multi-dimension scores of quadratic;
- Norms for general population
- Look at validity scaled only….
A USE NORMS FOR GENERAL POPULATION
What is she spends a long time answering and she is asking a lot of questions whats the best way to respond to her? To help her understand qns;
- not the PAI because it will take too long;
- ask the client to read out loud to check reading level;
- tell her to ignore the first 2 and answer the ones she can understand; or
- continue to explain the meaning to help her understand
- ask the client to read out loud to check reading level;
Q: On the PAI what if a client scores 60-69 on all of the subscales on DEP;
- they are avg;
- extreme end of the scale;
- that the client has mild symptoms of depression ;
- that the client is suffering from trauma;
- client needs anti d’s
Ans; mild transient
Q If someone has drug difficulties what would you look at how would you know people are improving in symptoms -
- drug scale score elevated to average etc - they will play around with the different ranges for the PAI and they will give you extreme ranges
If they fake dyslexia- reading ability is not consistent with his school - there’s not much you can say
If their delusions are intrusive it should pick up the delusions - you would have to see how the validity scales would come out
If the person can read the questions and they ask you to help - you can help but only a very little e.g. a synonym etc
Q:Child with academic difficulties and slow to start reading or pre-reading, co-ordination difficulties
5-11 mths old
WPPSY WISC ABAS WIAT SDQ
WPPSY (verbal and non verbal subtests) if child is non verbal its not great to administer
7yrs…still a WPPSY
7.8 mths do a WISC
Q. This child has no verbal language and has some difficulties in motor skill and co-ordination - what’s the best way to go about testing for that child?
You would use a non-verbal test
If option and the child is older than 5 you could do a Raven - progressive matrices 6-80 yrs
Or Stanford Binet. - all same areas verbally and visually -
WISC and WPPSY test different areas
In some cases fluid reasoning of WISC
WIAT when would you use that?
Achievement in school - especially with concerns about achievement and intelligence - that are not consistent with progress
If the child. Has an ID - maybe don’t do a WIAT - maybe only reading part - to identify specific learning abilities - start with cognitive assessment - and if doesn’t give you what you need you need to progress and do more assessments - it can be varied about what and why they are struggling with - they could be to smart and being bord - they could have attentional issues and could have hyperactivity issues - anxious and depressed
START WITH COGNITIVE and then going down different levels
WMS - what does the WMS test?
immediate VISUAL mem and DELAYED mem
immediate VERBAL mem DELAYED mem
Question around memory which cant be managed any other way
What is the ABAS?
Test of adaptive behaviour - how they function in different areas of their lives
When do you do an ABAS - only use when you have done away with WISC scores 70 and below and need to do ABAS - DSM requires a cognitive assess and adaptive behaviour for diagnosis with intellectual ability - some time borderline intelligence 70 -79
What does the Abas test for?
Test structure
Within three major adaptive domains (Conceptual, Social, and Practical), the ABAS-3 assesses
11 skill areas: communication, community use, functional academics, health and safety, home or school living, leisure, motor, self-care, self-direction, social, and work.
Some one has been identified with low cog abilities. - what test would you use to test functioning in everyday life?
ABAS - Adaptive Behaviioural Assessment System
Q you get referred someone who is having difficulties with starting a tafe course and they have information presented to them in class and information is presented visually and the TAFE psych has referred this person for possible learning difficulties - 20 yrs old
What test would you use?
The WAIS working meme Processing speed WAIS WMS WIAT ABAS
WIAT can be used with anyone and reading skills math skills and writing skills (learning test)
WAIS doesn’t assess visual memory - its all verbal memory
They want you to think what test looks at visual memory in adults is the WMS
WISC does look at visual memory for children
If its VISUAL MEMORY its about the WMS
Q What would a subtest such as symbol span measure on the WMS ?
Visual memory - symbols
Q: CRI score what’s the best job for you
Psychologist
Teach
Graphic Design
Marketing
Computer Programmer
Psychologist is more social as is a teacher
If there’s no social
Write down the main categories
What are the six areas on the strong interest vocational assessment?
Artistic Social Enterprising Conventional Investigative Realistic
Q. If you work in a hospital and you are referred someone from in the hospital for psych treatment and this person has been a patient in the diabetes clinic and someone has done a BDI and they scores very high on it - what sort of things do you need to pay attention to when interpreting the BDI? WHAT IS THE MAIN CONSIDERATION….FIRST THING TO LOOK AT
BDI is a Measure of severity of depression; follows the symptoms of depression -
- Who administered it
- Were they knowledgeable
- Age and gender of client
- How conscious they were when they did the BDI
- The Prescence of physical symptoms
- How motivated they were to complete the test
The Prescence of physical symptoms
Think - I am saying Diabetes for a reason - why are they telling me this???? Or the heart clinical -this person might have some physical symptoms
How many are physical symptoms in MDD - concentration, memory sleep - lots are physiological
Remember if the board gives you specific information they are giving you the answer - why are they telling me this bit of information I did not need - if I didn’t want you to pay attention to physical
This could be a confounding factor
Q: How would you describe the MSE?
a. Helps to make a diagnosis b. A test of psychopathology c. systematic behavioural observation of client d. brief screen of the clients functioning e. Helps you to detect malingering
c. systematic behavioural observation of client
Q; seeing a lady in her 70’s and 8-‘s and they have an MMSE result of 27 and they have lost their husband recently and they are low and unmotivated and they can concentrate - MOCA??
Dementia - major neuro cognitive disorder (one category)
Mini Mental Status exam - has scoring - short screen of cognitive functioning (look in the folders)
If the client is saying weird things and not make much sense - mainly done by GPS
Maximum score is 30 - if they have a neuro cog disorder they will struggle some of these questions
Anything below 24 is abnormal
Need to know that the cut off is above 25 - if they want you to think they have dementia score will be below 24 and if they do not they will be above 25
Not diagnostic but. Can give you an idea
Q; seeing a lady in her 70’s and 8-‘s and they have an MMSE result of 27 and they have lost their husband recently and they are low and unmotivated and they can concentrate - MOCA??
She has an MMSE of 27
What’s a possible differential diagnosis
MDD and grief MDD and adjustment disorder Dementia and MDD Dementia and AD Dis MDD and generalized Anxiety disorder
MDD and grief
If she has a score of 17 ….maybe dementia
THE HIGHER THE SCORE THE BETTER YOU ARE
Exam: A question about if you are given and Aboriginal child what test would you do?
Treat them as gifted
In any case you should question a test if they score low but not when they score very high
Maybe verbal comprehension would be low scores could be cultural - because they speak a different language at home
Sometimes but not all of the time the culture may or may not influence the problem
Don’t attribute everything to culture
An ab young woman in the city and exp social anxiety what’s the best way to establish rapport
Tell her its understandable because of culture….no NOT THIS ANSWER
It may not have anything to do with that
If they are older they have had the same education as peers so in that situation its not cultural and verbal comprehension
Telling you they have scored high on Depression scale (severe range) what do you do next
A. tell them to spend time in bahanmas
B. do further assessment and include detail in more in depth and other co morbid
C. Start evidence treatment
D. Send client back for meds to GP
E. Give psycho education about depression to client?
Answer is B further Ax
Q: you are at an industrial accident and you need to screen for PTSD symp and K10 and a specific PTSD scale like PCL-5 how would you do the testing? Everyone with PTSD screener and then K10 ; people who tested high on PTSD scale; K10 for everyone and only PTSD for people who tested 25 and above - you would do K10 and PCL 5 for everyone; you would only to K10 for non-direct and PCL 5 for direct witnessed
ANSWER: K10 for everyone and PTSD scale for higher scores MOD- high
Very basic scale you need to know
SDQ - Who is it for and what age group?
Children and adolescents 4-17 yrs
SDQ - can you diagnose from an SDQ?
NO - further assessment is needed
SDQ - What are the 4 problem scales?
Emotion
Conduct
Hyperactivity
Peers
What are the SCALES for the SDQ?
Externalising - conduct problems and hyperactivity scale
Internalising - Emotion scale and Peer Scale (20 max score)
Pro-Social
4 deficit scales and 1 strengths scale
Q what if you do SDQ and they score hyperactivity scale for the parents and the teachers - what would you do
Would you start treatment for ADHD;
start CBT for ADHD;
mindfulness and relaxation;
send to GP to refer to the paediatrician,
do a further assessment with parents and teachers;
tell them to work at a cafe in phuket
ANS send to a paediatrician for further assessment
If they trick you to starting Inx always send for further assessment
You’ve done an SDQ and they come out as high on internalizing
What would you do next?
The Child Behavior Checklist (CBCL) is a widely used questionnaire to assess behavioral and emotional problems. It is often used as a diagnostic screener, but autism spectrum disorders (ASD) are not included in the CBCL for school-aged children.
A client has a fear of catching some sort of infection or HIV working a hotel and has developed a ritual of washing hands with cleaning products
Health anxiety
OCD
Generalised anxiety
Health anxiety people don’t have rituals - they worry and worry and worry but no rituals - she ruminates but wont get tested
Someone comes to talk to you and they tell you a history of being anxious where they have to speak in public or talk to people they don’t know starting in high school- if they go to uni or a party and they get panicky, sweaty, chest hurts, worry about saying something stupid, clothes aren’t cool and they won’t fit in - she feels panicky and scared and physical symptoms
If trying to do a differential diagnosis btw panic and social anxiety disorder - GAD performance only MDD and BPD
What would you choose and why
ANS Social anxiety disorder
**Panic disorder is fear of having panic attacks **
Someone who presents saying that they are really upset because they get fired - no one understand that they are chosen as human being to develop some apps that will give him a lot of money and save human kind
Working day and night to do that, not sleeping and one day will be admired and adored all over the worl and is unfair people don’t believe him and speaks fast hard to interrupt
BiPolar 1
BiPolar 2
Bipolar 1 - because the mania was there - world will adore him ..borders on psychotic
Schizophrenia
Bi Polar 2 lots of people don’t have to be hospitalised- many BP2 become BP 1
The difference is the difference in severity of manic episode
BP 2 maybe promiscuous, buy too much, not looking after self, drinking too much - and was a big change but she was functioning - so it’s more BP 2 (not hospitalised etc)
If they are well it’s not mania - hypomania
Why not schizophrenia - how do they present if they unmedicated they are flat but they have disorganised speech- flat affect - lots of stories that make no sense - martians giving them power - a lot more disorganised
PTSD and acute stress disorder - When can you diagnose each disorder?
Acute stress - WIThiN 4 WEEKs
After 4 weeks if the symptoms persist - you give a diagnosis of PTSD
Q: Acute stress because; you can not diagnose PTSD until 4 week after the event - if they have PTSD symptoms
Acute stress
Adjustment disorder
GAD
PTSD
Why don’t we diagnose 2 days after - normal response to traumatic event - other wise evryone would have it
We give psychoeducation about what is happening put in supports and see what happens in a few weeks - they will always base it on time
TRAUMTAIC EVENT….ALWAYS BASE IT ON TIME
PTSD and adjustment disorder – what are the differences?
Adjustment disorder reaction to stressors in normal life that are not defined as traumatic events - what is a traumatic event
Fired from job is not a traumatic event
Traumatic - is life threatening life safety; physical health; is at risk - NOT BEING FRIED FROM A JOB
1st criteria for PTSD - has to be a traumatic event
What is the Difference btw MDD and Adjustment disorder?
For Eg romatic break up - do you diagnosis ADJ Dis - MDD may explain the disorder better - what if someone doesn’t meet full criteria for MDD and or other diagnosis.
Eg don’t meet full criteria for anything, both a bit depressed both a bit anxious - so could meet criteria for adjustment disorder
Might say client meets full criteria for MDD but you think they may have ADJ Dis - she doesn’t know - adJ can only be diagnosis if not better explained by a different diagnosis
Child presents to you and the parents say that they are struggling a bit at school, they aren’t organised, they keep loosing belongings, hit their sister without provocation, ignore instructions, impulsive acts,
ODD ADHD Autism Conduct Disorder SLD
Why ADHD not ODD ? What do you need for a diagnosis of ODD - the fact he hits his sister kids with ADHD
What do ODD kids do? Resist authority, grumpy, argue about everything, constantly try to defy their teachers , argue with other kids , angry very often, get in trouble a lot, defy and argue with authority, kids who get punished a lot - throw things around , upend desks
Nothing on that question indicated the client resist authority and was angry with the rules
What is the difference between ODD and Conduct Disorder?
Age is not the main difference- kids with conduct disorder are kids that break major rules and tend to do things that do things outside the LAW - start fires, hurt others, try to get power over other people - BECK YOUTH INVENTORY for kids, depression anxiety anger - self-concept and disruptive Behaviours - I like to hurt animals - which is more of a conduct disorder
Wanting to hurt animals is a big Conduct dis
Hot and cold kids - hot kids angry fight, no I hate you
Conduct is much colder, controlling and manipulative and breaks major rules
When they break the law you diagnose conduct
Very hard to work with cold manipulative
Conduct disorder 11- 18yrs - links between sociopathy etc
DRUGS and Disorders
With Lithium, most likely diagnosis is?
BIPOLAR
SSRI is used for which common disorder?
MDD will be the most likely diagnosis
The other thing with DSM - they will say what is the medication
Methylphenidate (Ritalin) is for which disorder?
ADHD diagnosis
So they may as what is the diagnosis if you take these drugs
Olanzapine - is for ?
Schizophrenia or psychosis
Clozapine if Olanzapine doesn’t work - only prescribed in hospitals if approved - for which disorder?
Schizophrenea
Clozapine - lots of side affects, weight gain - it’s a last resort
Needs to be dispensing hospitals
What drugs would you use for Schizophrenea?
Clozapine if Olanzapine doesn’t work - only prescribed in hospitals if approved
Q Husband died 2 yrs ago - daughter says that her mum started withdrawing from activities, gradually but worse in the last year - got lost going to local shopping mall - forgets things, doesn’t like going out much
ADJ Dis Bereavement MDD Major Neurocognitive disorder (dementia) GAD
Major Neurocognitive disorder (dementia)
Why do you think some people withdrawing, etc diagnose MDD? Because there seems to be an understanding that at a certain age MDD affects memory -lost in shopping center is more neuro cog
If they have symptoms you go AHHH, maybe memory can be forgetful -
Q: Someone presents in your waiting room and he tells you that he is too excited and is walking around the room and can’t sit down now and wants to tell you how amazing he feels and he is devising this amazing apps. - talks fast and elevated and you look and think what is happening?
What 2 disg would you think
Drug use and amphetanmine Alchol and schizo Bi Polar Di and Alcohol Amphetamine in tox and schis Amphet and hypo manic episode
Amphet and hypo manic episode
Talking to a client who has panic disorder GP prescribedValium taking 2. day pe and she says that you are amazing and she is going to stop taking valuim
1. Congratulate for taking charge of anx 2. Recommend drug that you sell or pharmacy 3. Call the GP to let them know the client has stopped meds 4. Tell them now they are doing well go to Bahamas 5. Continue treatment as it has helped her
- Call the GP to let them know the client has stopped meds
If you stop taking Benzo’s after 6 months - they can DIE - they can have a seizure
WHAT ARE BENZO’s so you know to contact the GP (Valuim and Xanax) Lorazipan, Diazipan (Valium) , Tamazipan - Always TALK TO THE DOCTOR ask
Talkking to a client who has panic disorder GP prescribed zanax and she is increasing the dose and frequency more and more just to cope with work and how she feels
1. Tell client to stop using zanax 2. Tell client that you need to refer to specialist - with benzo addicitions 3. Send them to medical center for treatment of addictions 4. Call GP immediately to discuss zanax and you call GP with your concerns 5. Continue treatment of panic as you are not DR
- Call GP immediately to discuss zanax and you call GP with your concerns
Zanax and other benzos are very addictive and its hard to stop taking them
What the point? A technique for CBT
1. People need to increase depth to increase oxygen 2. Client needs to expand their abdomen when they draw in air 3. Need to tighten their muscles when they inhale 4. Increase their rate of breathing to inc carbon dioxide 5. Client needs to learn to inhale from the upper chest
- Client needs to expand their abdomen when they draw in air
You are trying to decrease oxygenation - that is the point of breathing training
Point is to slow breathing, bring air to abdomen - make breathing cycle longer to decrease oxygen
When anxious we breathe really fast …and then we hyperventilate and too much oxygen in the blood stream - we need oxygen to fight or flee - but we are not going any where - amygdala gets triggered
Tell amygdala everything is fine - SLOW DOWN YOUR BREATHING - a small change can trigger change in the bottom
If you are working with spider phobia what is the best next move
1. Movies with spiders 2. Live spider in hands 3. Psycho education 4. Teach relaxation 5. Do psycho ed to slowly introduce exposure
- Do psycho ed to slowly introduce exposure
Treating a 60yr old ma -he has social anx and you are trying to get him to identify thoughts and he tells you he can’t remember any thoughts - what is the best way to proceed
1. Send him to the GP 2. Review the case formulation and get more info 3. Teach the client relaxation and meditation to see if he becomes more aware 4. Provide a reference event to discuss with the client of a specific experience 5. Change to a different method because cog restruct won't work with him
- Provide a reference event to discuss with the client of a specific experience
Someone invited to gymnastic team and suddenly feeling as if she is an imposter and she wont measure up to the the team - Performance anx
1. Relaxation training and rehearsal of skills 2. Supportive counselling goal setting 3. Problem solving and goal setting 4. Skill rehearsal and assertiveness training 5. Cog restructuring and imaginal exposure
Cog restruc and imaginal exposure (gold standard for anxiety)
Q: you have. Guy who had a car accident a year ago and someone died and he was injured and still can’t drive - takes ubers everywhere and he is diagnosed with CBT - what is the next step once you explained diagnosis and treatments
1. Imaginal exposure - car accident 2. Psycho education trauma to driving 3. Treating Relaxation strategies for driving 4. Give him ubers as avoidance 5. Grief counselling over loss of friend in accident
Psycho- education is the first step
Imaginal exposure is evidence based for PTSD
Use schema therapy with complex PTSD - some power to rescript the imagery
You’re seeing a child who is 10 and is diagnosed with ADHD and parents re ok to try meds and would like. A long term solution; what you be an effective intervention?
Relaxation training Parent management training IPT Narrative therapy Exposure therapy CBT with child Neurofeedback
Definitely no CBT for ADHD
NO Neurofeedback
Zinc, magnesium - diet
The only thing that works with ADHD is meds and parent management training
You are a consultant and you’ve been asked to go to a business where there was a robbery about a week ago and the managers asking you to go and interview the people who were at the company and you discover some a reporting symptoms of PTSD
1. Start evidence based tx (-1) 2. Refer to a specialist for treatment (=1) 3. To bring all staff together and give them some debriefing 4. To follow up staff for the next month to see whether they have ongoing symptoms 5. To give them to do prolonged exposure for staff with symptoms( =1)
- To follow up staff for the next month to see whether they have ongoing symptoms
Critical incident debriefing has been completely DEBUNKED … actually more harmful doesn’t stop developing PTSD and can make it worse for those exposed due to vicarious trauma
Then make a decision to start treatment if they develop PTSD
Your doing CBT for trauma and you decide to (PTSD diagnosis) and you start Trauma-focused CBT - what are rhte main things to do with the client
1. Relaxation training Imaginal exposure 2. Cog restruct and relaxation 3. Cog restruc and imaginal exposure 4. Pleasant events schedule - cog challenging 5. Relaxation and mindfulness 6. Cog restructuring and invivo
- Why? Has cog and behavioural components
NOT INVIVO -because you can take them back to the trauma in real life - that’s impossible
Maybe use prolonged imaginal exposure
No evidence that relaxation helps process trauma
Consider what is evidence-based
If treating PTSD symptoms - relaxation training doesn’t help
She finds very few people who use it and can get something out of it outside of the session
When you think about treatment in terms of the board and how they see it - is the treatment targeting any of the main symptoms
General Wellbeing v’s antibiotics for sore throat
Relaxation - Not for social anxiety or PTSD or fear of spiders - not helpful
Q: Client has Fast changing ideas, unrealistic loses train of thought
Delusional Depresseion with psych Hypomania Alcohols inx GAD
Hypomania
Seeing client and tells you can not go to work - no work 4-5 yr, stays home a lot, inappropriate thoughts all the time (sexual) see’s as few as possible is her life, and when she has the thoughts she gets very distressed, ever time she goes in public, she recites prayers to counteract - OCD? How do you talk about the sexual thoughts,
Compulsions
Obsessions
Ruminations
Dellusions
Prayers are compulsions and sexual thoughts obsessions
Trying to think of something neutral
What is the client using to reduce the anxiety - thought or behaviour is the compulsion
No questions on ICD
Q: Anorexia - if someone comes to you and you have decided that this person has anorexia - what are the first things to do after making the diagnosis ?
Start treatment please eat more Stop working na Get support from friends Consult with your GP You go bahamas
Work with GP have medical check up and have follow up from them
What is not consitent with a diagnosis of bulimia in terms of how they present?
Episodes of binge eating Feeling quite low they don’t like body Being significantly over weight Vomitting after meals Having a sense of lack of control whilst over eating
Being significantly over weight
You are seeing a child and he is doing well at maths at school doesn’t adapt well, and struggles socially. Which is characteristic of ASD?
A routine preoccupation Negative evaluation by peers Low planning ability Repetition Impulsivity and hyperactivity
communication and social deficits and repetitive and restrictive
Difficulties with social communication and repetitive and restrictive and interests
How do you ensure the validity of behaviour observations?
1. Do you write every behaviour 2. Stay hidden so no one knows 3. Ask the teacher to do it 4. Choose a certain number and intensity and frequency 5. Every possible behaviour in 10 minutes
- Choose a certain number and intensity and frequency
When do you do behaviour observations?
With young children / elderly people
Parents deciding on some behaviour issues at school
Differing opinions btw parents and teachers
Or people aren’t good at specifying Behaviours
Non-verbal clients
ASD children
If there are no issues at home don’t do them
Don’t do it in places where there are no issues with them
A child presents to you and the parents say that they are struggling a bit at school, they aren’t organised, they keep losing belongings, hit their sister without provocation, ignore instructions, impulsive acts,
ODD ADHD Autism Conduct Disorder SLD
Why ADHD not ODD ? What do you need for a diagnosis of ODD - the fact he hits his sister kids with ADHD
Somatic Symptom disorder - the person has had an accident and have become preoccupied and it’s a minor injury and they have come back to work and dr says she is fine but she thinks she isn’t
Somamtic symtom disorder]Health anx Conversion disorder Malingering Malingering Social Anxiety
- Somatic Symptom Disorder
Health anx and Som symptom disorder difference…. Health Anx don’t have symptoms
They are worried about getting sick but don’t have symptoms - maybe and accident - but worried about catching something
Somatic Disorder they have physical symptoms
Difference btw conversion and somatic symptom disorder?
Conversion disorders are usually affecting motor or sensing dysfunction- people who can’t see, or can’t walk or have lost strength in their right hand or non-epileptic seizures with no medical reason - functional
PPPD - Yes, e.g. Persistent Postural-Perceptual Dizziness
Somatics have physical symptoms of pain - perception of pain is exaggerated or perception of pain is exaggerated
You are seeing a client who is a young mother with 4 kids under 5 and twins in the middle and she is very teary and referred for treatment and scores high on DASS on K10 for stress and depression and she is afraid she is not being a good mother - what is the first step
Start identify difficulties being a mother
Listen explore and validate
Assess capacity to be a mother ie mandatory reporting
Discuss supports she needs and give her some advice she can give supports about a parent
5 look at medication
Listen Explore Validate
A guy can’t drive out of the local area first step
Explored with the client for reasons in areas to drive in
Develop fear hierarchy with goal of getting him driving out of local area
Send him for a driving ability assess
Do you assess his assessment driving outside local area
Start a PTSD assessment
What worries him about areas and different areas and what’s happening
The structure interview
Then assessments
Seeing someone physical injury and chronic shoulder pain and says I came because my dr said it would be good for me to come and I don’t know why I am here and I don’t understand what a psych can do with real plan
Say I’m sorry I can’t work with you and send back to dr
Start an assessment of their pain and Behaviours
Explore his willingness to do psych therapy +1
Gather more information and explore his reason for resistance
Going to evaluate whether this person can engage in treatment. -1
You need to explore the underlying reasons he doesn’t want to come to treatment
When people resist they are telling us something …..why?????? You need to find out about the reasons and explore
You need to explore the underlying reasons he doesn’t want to come to treatment
When people resist they are telling us something …..why?????? You need to find out about the reasons and explore
Q: What interventions are NOT supported by evidence in the treatment of PTSD
Prolonged ex TF CBT Thought field therapy (TFT) tapping Psychodynamic EMDR
BOARD WILL GIVE CONSERVATIVE ANSWERS
Thought field therapy (TFT) tapping - EFT not considered by the board as having any evidence in treatment of PTSD
Prolonged ex TF CBT Thought field therapy (TFT) tapping - EFT not considered by the board as having any evidence in treatment of PTSD Psychodynamic (evidence for trauma) EMDR
BOARD WILL GIVE CONSERVATIVE ANSWERS
Exam: normally ask about driving phobia - seeing someone with a driving phobia, they had an accident a year ago and are not able to drive - what approach will be the most effective
Imaginal Socratic Narrative MI Cog Restructuring
Imaginal
Socratic
Narrative (board won’t consider this for anything)
MI
**Cog Restructuring (Based on Socratic questioning rational disciplined way to answer questions)
Anxiety ONLY CBT -
You are doing CBT nothing is happening and not getting better if depressed
Continue CBT to death
Try a different approach
IPT
Continue CBT to death
Try a different approach
IPT
So if depression use IPT but start with CBT and go to IPT
Don’t need to remember hierarchy of interventions
Need to know about types of exposure and the different types
Exam Q; that said if you’ve seen a client 3rd session - what would you do?
Paraphrase
Reflection
Empathy
I think the answer is emapthy to this
Dissociation history of trauma physical symptoms, no medical reasons , when you ask for triggers she cant articulate her triggers for physical symptoms - what process would you follow
De-sensitization
Graded exposure thought challenging
Send her back to the Dr to go back to meds and psych treatment
Work on ability to verbalise thoughts perceptions to put into words - identifying emotions
Interpersonal relations
Work on ability to verbalise thoughts perceptions to put into words - identifying emotions
They may try to trick you and make it too simple
They will also ask simple things - don’t complicate them …if its simple …its simple
Q: You have been doing CBT for 12 sessions and it’s not working what would you do?
CHOOSE IPT - evidence for others
What are the key issues that IPT is useful for?
- Grief and Loss
- Interpersonal Disputes and
- Role transition
- Interpersonal Sensitivities
Q: You are doing IPT with a client and the client in the 2nd session they are happy and like you and never wants therapy to end - what is the best way to deal with this from an IPT perspective
1. Ignore it - IPT not psychodynamic 2. Address transference as very important for IPT 3. Address quickly so I don’t have further problems with the client 4. Focus on interpersonal relationship function 5. Let that develop and deal with it as you go
It’s a sign of something happening in their interpersonal relationships - it’s not a big problem but it needs to be addressed
5?/????
Working with IPT and guy has problems with adult daughter?
1. Prob solving and comm analysis 2. Cog restrcu and thought monitoring 3. Free association and free association 4. Pleasant events scheduling and cog restruct 5. Distress tolerance and emo regulation
- Prob solving and comm analysis
What would IPT look at in relationship conflict and interactions?
Individual style Attach style Cog distortions Schemas Genetic predisposition
Attachment style
Main thing to attend to if you decide to extend treatment
Other exp loss ans termination Focus remains of current sympt and problems Finnish dealing with transference Aware of all cog distortion Treat another time
Focus remains of current sympt and problems
Q: How would you support someone who has come to you and at first they didn’t think they had an alcohol problem but now they acknowledge they have an issue - once they have some goals what is the most imp next step
Send back to GP to explore any medical issue
Ask to keep a journal of drinking to reduce resistance inclined to change
Work to inc self-efficacy - plan of action together
Explain different treatments
Teach client a number of strategies they can use
Work to inc self-efficacy - plan of action together
Its never tell people how to do something
Q: If I am doing a group for stress reduction in an international company and I have a number of groups running - what are important things to include;
1. Include MI 2. Include relaxation 3. Invivio exposure 4. Leadership skills
Know the main words and concepts
- Include relaxation
Exam; Talking to a guy who wants to talk he’s been down, he’s fired from his job and he wants to talk about career options and you want to use a problem solving approach …. Talking to a friend in a systematic way - we see the pro’s and con’s
Focus on his preferred future
Do a vocational assessment
Do some imagery
Systematically look at all solutions to problem - analyse pro’s and cons and
Systematically look at all solutions to problem - analyse pro’s and concs and
Be clear it’s not solution-focused it’s a PROBLEM solving approach
PROBLEM-SOLVING APPROACH systematically looking at all of the problems
Wife said he going to leave and she has asked him to change for years - what would you do?
1. Behaviour change mgt techniques 2. Keep a diary of all problematic Behaviours 3. Psychoeducation about good couples relationships and books to resd 4. Discuss preferred future with his wife 5. Cog restruck on thoughts about marriage
Discuss preferred future with his wife
You are seeing a single Mum who is concerned about her relationship with her teenage daughter, she has 3 teenage daughters and she tells you they can’t really communicate without shouting and screaming so you decide to get Mum to bring the daughters to bring into ther room together - what will you focus on
1. How motivated is esch member to imp comms 2. On the psychopathology ( who has MDD etc) 3. Who has the power in that group 4. Who is more engaged in the group 5. Discern the patterns of behaviour with in the system
- Discern the patterns of behaviour with in the system
Who escalates, who withdraws, who tried to mediate, analyse what is happening - patterns
NOT Psych Ed- Behaviour Management
Seeing a family and 14 yold is shopllifting which is out of character and you find out his older brother died in a motorbike accident - what is your focus?
Talking about behaviour mgt with parents
Psycho ed grief and loss
Understanding the function of the shoplifting
Give them grief counselling
Working with the boy around his thoughts and feelings for the loss
Understanding the function of the shoplifting
A girl close to Mum and Mu is relying on the daughter for her own needs and support based on your assessment and you decide to see as a family and girl is presenting with eating concerns and depression - how ywould you work in the contecxt of this presenttion
Strengthen aliiances
Ask for preferd future
Psycho ed depression and Eating in adolescents
Encourage adolescent to individuate - define boundaries in the family in system
Develop insight into system - by working with adolescent by promoting self understandings
Encourage adolescent to individuate - define boundaries in the family in system
The way to help adolescents is to help define boundaries
Working with a client and they remind you of your mother and you have issue and you find yourself reacting to this person and you feel anxious talking to her - would you call that?
Transference Counter transference Therapuetic relationship Resistance Avoidance
Feelings to do with the therapist based on the past - COUNTER Transference
In terms of outcome - you are trying to evaluate an anti bullying treatment program how will evaluate how effective that is
CBCL self report at beginning and end CBCL Teacher and end SDQ at beginning and the end Measure anti bullying Measure teachers corners 3 before and after intervention
If you are asked to look at an outcome - by measuring behaviour e.g. bullying
You are doing some staff selection for a job and you are looking at the candidate doing some problem solving in groups looking at a number of behaviour and criteria
How they solve the problem How they talk to each other How they demonstrate leadership skill Set target behaviors and how they meet target behaviours How they answer questions form others
Set target behaviour and how they meet target behaviours
If a set behaviour is how they help others that is what you will review
How do you choose bwt one and another where they have a similar effect size but one has more studies than the other, how do you choose
What the client prefers
Effect size and you pref and expertise
THE ANSWER IS on client preference
What is a small medium and large effect size?
Difference in mean btw control group and the group where you did an intervention
WHAT IS A SMALL MED AND LARGE EFFETC SIZE
SMALL 0.2 small
MEDIUM 0.5 medium
LARGE .8 and above is a large effect size
Mean of results for treatment group is 1 SD btw mean of treatment and control group if the difference is less than .2 there is no evidence its effective .2-.7 medium .8 and above large
What is the advantage of a meta analysis?
- Main reason for the board and APS -
- it gives you a bench mark to compare efficacy of interventions
ABA Design is ….
A. First condition without intervention measure variable at baseline
B. Introduce a treatment
(A) Remove the treatment and measure again
So you can compare A to B and compare B to A
About the proof if the treatment worked
stochastic
having a random probability distribution or pattern that may be analysed statistically but may not be predicted precisely.
Seeing a young woman who presents as aboriginal and lives in Sydney and presents because she is experiencing anxiety - what would be the best way to establish rapport and a good alliance with this client?
1. Recognising and telling her there are cultural reasons for anx 2. Starting with psycho ed about anx 3. Recognising her cultural reasons for anx 4. Didactic and psych ed for anx 5. Recognise its impr to share some of your family info 6. Exploring whether alcohol and other drugs Explain people from Sydney aboriginals are the same as all the other
- Recognise its impr to share some of your family info
How could you help an aboriginal man who has AOD and MDD how can you help this client?
Do some assessments
Discuss harm minimization
Do exposure hierarchy to address symptoms
Refer him to detox to help with alcohol use
Let the client tell his story without direct questioning and avoid eye contact
Let the client tell his story without direct questioning and avoid eye contact
What does an aural report include
1. Every detail of sessions 2. Does it provide a lot of details of people can undertstand 3. Short introduction 4. Background assessment treatment plan outcomes so far and questions 5. All the raw scares of all assessments
- Background assessment treatment plan outcomes so far and questions
SPECIFIC, GOOD GRAMMAR, PROVIDE SPECIFI INFO- spelling or grammar errors in wrong answer
Reports need consent
Make sure they only have observed facts
Concerned about social difficulties, teacher wants help to improve academic performance what do you do the report on?
Focus on clients strengths and weak Help with social performance Help with Body image Strat the help explain why client is having difficulties of To help improve academic performance
To help improve academic performance
If competing requests - just do one report with recommendations that are relevant
Seeing someone physical injury and chronic shoulder pain and says I came because my dr said it would be good for me to come and I don’t know why I am here and I don’t understand what a psych can do with real plan
Say I’m sorry I can’t work with you and send back to dr
Start an assessment of their pain and Behaviours
Explore his willingness to do psych therapy
Gather more information and explore his reason for resistance
Going to evaluate whether this person can engage in treatment.
Gather more information and explore his reason for resistance
