FINALS STUDY GUIDE

Question 1

Factors important to establishing and maintaining the therapeutic alliance in CBT

Answer 1

• empathy
• genuiness
• non possessive warmth
• unconditional positive regard
• focus attention on client

Question 2

Characteristic Pattern of Thinking: Guilt

Answer 2

• broken his or her own idiosyncratic rules of what is fair and just
• I should have done that’ or ‘It’s my fault’
• judge themselves to be totally bad and overlook their strengths.

Question 3

Characteristic Pattern of Thinking: Shame

Answer 3

• undesirable qualities/behaviours
• see selves as total failure
• if others see them in this way ridicule/drives behaviour
• aim to hide these un- desirable qualities

Question 4

Characteristic Pattern of Thinking: Anger

Answer 4

• someone else has broken individual’s idiosyncratic rules of fair/just
• Typical thoughts include ‘shouldn’t’ or ‘mustn’t’ statements

Question 5

Characteristic patterns of thinking: Anxiety

Answer 5

• increased perception of danger
• decreased perception of ability to cope with danger
• thoughts, vulnerability, loss of control, fear of social ridicule, physical harm and death
• more prone to scan for potential threats than controls
• lower thresholds for noticing potential threats

Question 6

characteristic patterns of thinking : Depression

Answer 6

• more negative about things, self, world, future,
• impaired problem solving
• longer retrieve positive memories
• easy access negative memory

Question 7

What compromises thought?

Answer 7

• memories of the past
• comments on the present
• predictions about the future
• images/mental pictures.

Question 8

distinguish between feelings/thoughts

Answer 8

• I feel angry (feeling)
• I feel like a failure (thought)
• the word ‘that’ or ‘that I’m a’ can -I feel that I’m a failure’. (Thought)

Question 9

Define schema, how does a schema develop and get maintained?

Answer 9

-once developed you have schema glasses and see everything through those lenses and only pay attention to what fits schema

DEFINITION

• structure for screening, coding, and evaluating stimuli that affect organism
• rules that govern information processing/ behavior’

DEVELOP

• information processing theory
  
  • we group experiences into categories to understand/organize world
• develop as part of normal cognitive development

MAINTENANCE

• powerful maintenance function for problems -schemas determine what we notice/attend to/remember of our experiences
• maintained in the face of contradictory evidence through distorting/not noticing/ or discounting contradictory information

Question 10

What is an alternative schema?

Answer 10

• more adaptive schema (start to put a new one in place)
• involves not only testing maladaptive beliefs but identifying/strengthening alternative more adaptive schemas.
• alternative schema must be developed before the client will be capable of looking at the evidence
• psychodrama
• continuum
• sentence completion

Question 11

How does change/growth occur according to CBT? What are the goals of this approach?

Answer 11

• Time limited
• insight and action oriented
• want a change and shift in insight and behavior

Question 12

Specific goals of assessment in CBT (2)

Answer 12

(1) arriving at a diagnosis to describe client’s symptoms
(2) arriving at a tentative explanation of the client’s symptoms in cognitive-behavioral terms that can then be used to plan treatment.

Question 13

Goal of determining diagnosis

Answer 13

• cant have treatment plan without formal diagnosis

- helps to identify specific techniques for that specific diagnosis

Question 14

The Cognitive Model

Answer 14

• it is not events themselves that affect our behavior but how we perceive events.
• single situation can elicit various emotional/behavioral responses, depending on how the person perceives the situation.
• when people find themselves in situations, automatic thoughts activate and influence their core beliefs and intermediate beliefs
• different people/different reactions to same event

Question 15

Cognitive Restructuring (definition, application, techniques, goals) *

Answer 15

DEFINITION
-identifying and reframing maladaptive thoughts

APPLICATION

• Rather than treating automatic thoughts as “truths,” involves questioning our thoughts and reframing them if they are irrational or unhelpful
• single situation has many possible interpretations.

TECHNIQUES

• in vivo exposure, social skills training, relaxation training, and structured problem solving
• based in learning theory and involve unlearning old, maladaptive associations between stimuli and our responses while also learning new ones.

Question 16

Maladaptive Thoughts

Answer 16

-ideas that interfere with ability to cope that cause pain or excessive emotional reactions (CBT)

Question 17

Homework (use of it in CBT, why client’s may be noncompliant and how to deal with that, importance of client compliance) ✔️

Answer 17

• gives you a lot of information
• real change or growth happens outside of session

WHY CLIENT NONCOMPLIANT

• clinicians taking too much control over the assignment. Early appropriate for clinician/Later on client.
• lack of time (work through process of planning)
• homework too difficult or too time-consuming.
• worried about doing it “incorrectly” and being judged negatively by the clinician.

HOW TO DEAL WITH
-reinforce him or her for what he or she has done and then gently make some suggestions for improvements on the next assignment.

IMP COMPLIANCE

• related to treatment outcome
• Homework affords greater opportunity to practice new skills than just coming to therapy once per week
• allows clients to practice these skills in the “real world.”
• When clients try things out on their own and see positive results in their own environments, they often feel a burst of confidence

Question 18

Mental Status Exam

Answer 18

• when in doubt during initial interview and have questions about psychiatric health or organic brain disorder
• description of the patient’s appearance, speech, actions, and thoughts during the interview
• based on observations made over the course of the assessment

Question 19

Case Conceptualization ✔️

Answer 19

• working hypothesis of how the client’s particular problems can be understood
• precipitants
• how long has been going on
• contributing factors
• what contributes to the behavior
• conceptualization enables the clinician to think clearly about the reasons for, and the relationships among, these symptoms
• collaborative

Question 20

habituation ✔️

Answer 20

• an organism’s decreasing response to a stimulus with repeated exposure to it
• the longer you stay in a situation, the less anxious you’ll feel. And the more times you go into that same situation, the less anxious you’ll be.

Question 21

Fear Hierarchy/SUDS (define, understand use) ✔️

Answer 21

list of social situations that either completely avoided or that he did enter that caused a great deal of anxiety

• rated 0-100 Subjective Units of Discomfort Scale (SUDS), where 0 no anxiety at all, and 100 represented the most severe social anxiety
• items in the hierarchy were rank-ordered according to these anxiety ratings from least to most anxiety-provoking.

Question 22

Collaborative Empiricism

Answer 22

• best exhibited when the clinician uses the technique of Socratic questioning
• you would like to know what they think
• that they can help you to understand their experiences
• in turn, you can guide them to come to their own solutions for a problem.

Question 23

Working with suicidal clients/Interpersonal Theory of Suicide

Answer 23

-document everything
-seek supervision
-consult with colleagues
INTERPERSONAL THEORY OF SUICIDE
-only certain people are capable of attempting suicide (those that can build up to this capability through a process of exposure and habituation)
-of those who are capable of attempting suicide, individuals must desire suicide
-proposes that individuals desire suicide when they
(1) perceive that they are a burden to others and
(2) believe that they do not belong to a family, group of friends, or some other valued social group.

Question 24

Handling personal questions, gifts, social events, facebook

Answer 24

PERSONAL QUESTIONS
-takes the focus off the client who is paying money
-refer to your professional experience
-appropriate to normalize clients’ difficulties and point out that on some level, you have had similar experiences
GIFTS
-Gifts offered during therapy trickier to deal with than a single gift offered at the end of a successful course of therapy
-outside of formal gift holiday trickier
-high monetary value never accept same as cash or less value but frequently
-behavior in therapy mirrors and buying peoples affection could be a behavioral trait in outside world
SOCIAL EVENTS
-never participate in social activities like playing golf or going for coffee outside of therapy with our clients
-frequent invitations could be sign of loneliness or misplaced attraction best approached in counseling
-when refusing, first express great gratitude for the invitation, explain you make it a rule usually to protect privacy of patients
FACEBOOK
-initiating a friend’s request can be considered a breach of confidentiality and simply should not be done, not even with former clients.
- when friended call the client on the phone and simply say that you really appreciated their friend request but that you make it a rule to not do any social networking with clients.

Question 25

Reasons and solutions for client non-compliance (homework, opening up to therapist, talking too much, angry clients, overly compliant)

Answer 25

HOMEWORK
Reason:
-lack of time,
-worried about doing it incorrectly and being judged,
-too hard or time consuming
Solution:
-integrate or re-explain why so important to outcome
- there to teach new skills not to judge,
-engage clients in redesigning
OPENING UP TO THERAPIST
Reason:
-worried about confidentiality
-negative experience with clinician or violated by people in their lives
-fear of negatively judged
-fear of critical feedback of symptoms
Solution:
-be direct—but in an empathic way
- First, make an observation to the client (e.g., “You seem reluctant to talk to me about these difficulties”) and then pose an open-ended question
-talking sign of courage
TALKING TOO MUCH
Reason
-clients simply do not know what is expected of them in the therapeutic setting
-anxiety (could be diversion tactic)
-talkativeness can be related to specific psychological problems. (OCD)
Solution
-acknowledge this and reassure clients that there is a framework to their questioning
-leave time in end for chatting
-bringing up this problem in therapy and helping clients to acquire better social skills.
ANGRY CLIENTS
Reason
-have tried to improve their lives on their own with limited success.
-might keep these concerns bottled up. When they feel frustrated, their frustration emerges as anger
-might have grown up in homes in which anger was frequently exhibited.
Solution
-not get “sucked into” the anger. Instead, view it as another window into the client’s life for case conceptualization
-“You seem very frustrated today. Can you help me to understand why?”
-ground rules (no yelling in session)
-working on anger management in therapy
OVERLY COMPLIANT
Reason
-the motivation for doing the work of therapy was coming from her desire to please, instead of from intrinsic motivation to get over her condition
Solution
-taking a more active role in designing the homework the client felt that she had herself to answer to—not just the clinician.

Question 26

Confidentiality

Answer 26

• is achieved through HIPPA (regulates the way that protected health information is communicated ) and consent forms
• should discuss confidentiality in first meeting
• FIRST, tell client how important confidentiality is to you and clinic and bound by law
• will not speak about them with anyone except your supervisor, other clinicians who attend group meetings with your supervisor, or other people at the clinic who are directly involved in their care
• discuss the specific circumstances under which confidentiality must be broken (state laws mandate)
• can be broken when you are doing employee assessments for an employer, student assessments for a school district, or assessments that are ordered by the court because you are working for that third party not the client

Question 27

Confidentiality can be breached because?

Answer 27

Client should be made aware

(1) they threaten to harm themselves;
(2) they threaten to harm specific other persons;
(3) they tell you about the abuse of a child; or
(4) their records are subpoenaed by a court of law. Some states and provinces also have other mandatory reporting laws (e.g., mandatory reporting of abuse of adults who cannot protect themselves).

Question 28

Confidentiality: Essential and important points

Answer 28

IMPORTANT POINTS
Consent must be obtained for assessment and therapy.
Written consent is superior to oral consent.
Let clients read through consent forms at their own pace, check that they have understood what they read, and invite questions.
Clients should also be presented with a statement of the clinic’s privacy practices (HIPAA document).

ESSENTIALS
Clients must understand the purpose and nature of the activity.
Clients must be informed about likely benefits and risks of the activity.
Clients must be told of alternatives to the activity (e.g., other treatments) and likely consequences of nonaction.
Consent forms must also make clear that clients can refuse to participate in the given activity or withdraw at any time without prejudice.
Consent forms must also include a discussion of confidentiality protections and limitations.

Question 29

Role of the supervisor

Answer 29

TRAIN BEGINNING CLIENTS

• in assessment
• case concept
• how to be a therapist
• ethics
• constantly evaluate
• skills

ENSURE THAT CLIENTS RECEIVE COMPETENT CARE

• supervisors are legally and ethically liable for any harm done by a trainee under their supervision
• must always be aware of the status, treatment course, and current level of functioning of each client

SERVE AS MENTOR

• help chart trainees career path
• helping trainees develop their own supervision skills

Question 30

Terminating therapy – CBT is time limited and teaching client to be their own therapist

Answer 30

KEEPING THE END POINT IN MIND (cornerstone of cbt time limited)
-provides clients with some external pressures to make changes by a specific time (motivation)

TEACH CLIENTS TO BE OWN THERAPIST
-framed as positive step from the beginning so they can use their newly acquired skills to deal with their difficulties on their own

LAST COUPLE OF SESSIONS

• needs to have a clear sense of what he or she has accomplished
• needs to set some goals for the future
• must ensure realistic expectations for the future
• must know what to do if symptoms reemerge.