Intervention Flashcards
A client you have been seeing for a while is especially emotive in session. He or she is crying and describing a situation that has upset him or her greatly. When reflecting the feeling back to the client:
A. Just state what feeling has been observed so as to not interrupt their emotional expression.
B. Connect the feeling expressed to the circumstances noted by the client in a “you feel x, because y” manner”.
C. Simply focus on the client’s thoughts and actions, as you know that will refocus attention from their feelings and help them regain composure.
D. Focus on the problem so it can be solved and the client can feel better.
E. Model the feeling to increase the accuracy of the reflection.
B. is the most appropriate response. If one reflects feelings, includes their context, and includes “check out”, they are more likely to help the client both feel understood and help the client understand their own emotional reactions. Moreover, they are more likely to correct the therapist if they are incorrect if a “check out” is added. This aids in understanding as well as developing the therapeutic relationship.
A particular psychologist starts all their contacts with new clients the same way. Before gaining information from the client, they note the purpose, duration, cost, and the nature of their first psychological contact. They inform the client of the limits to confidentiality and how they tend to structure their work with clients. One impact of psychologists structuring first contact with clients in this way is that:
A. Reduces premature termination.
B. Makes clients reticent to talk openly as they are now concerned about the limits to confidentiality.
C. Increases the likelihood that the client will not return to therapy as a therapeutic relationship was not established at the start with a psychologist showing interest in them as a person before structuring their time together.
D. Increases client anxiety.
E. Reduces clients resistance to change.
A. is the most appropriate response. The main benefit to structuring first therapeutic contact is to manage client expectations and thus reduce premature termination where a client leaves services before a positive result is realised.
A psychologist has had a difficult night’s sleep as a neighbourhood dog was barking loudly at night. As a result, the psychologist is feeling tired as shown in their sitting with their legs crossed, slumping in their chair, and generally not paying attention to the tone of voice and eye contact being provided to the client. What is the possible impact of the relaxed attending skills presented by the psychologist?
A. The client will likely feel that the psychologist is not very interested in their situation.
B. Minimal, the client will probably understand that there is an explainable reason why the psychologist is like this.
C. None, clients do not pay much attention to attending skills provided by psychologists.
D. It depends on how much contact the psychologist and client have had up to this point. If this is a first meeting the impact could be serious as the client will not return for psychological services if they do not feel attended to. If this is a continuing contact scenario, then a strong therapeutic alliance can withstand a relaxing of attending skills.
E. It depends on how much contact the psychologist and client have had up to this point. If this is a first meeting the meeting could be minimal as the client does not know what to expect from, the psychologist. If this is a continuing contact scenario, then a therapeutic rupture could result as the client is used to being attended to.
A. is the most appropriate response. Basic attending or social skills are important for the establishment and continuation of a therapeutic relationship. Basic social skills aid in communication and thus need to be used by psychologists in order to communicate clearly and to model appropriate social behaviour.
Responses reflecting client content can be relatively short as well as more detailed. When is a longer summation reflecting client content more appropriate?
A. At the start of the first session, based on the intake form or client referral.
B. At the end of the session.
C. At the end of treatment or at mid-treatment review.
D. At the halfway point of any session.
E. Answers B, C, and D.
E. is the most appropriate response. A summary of client content can occur when appropriate and especially at the start of a subsequent session, midway in session, and the end of the session. Summations can also occur during larger chunks of therapeutic time as well including midway through and at the end of treatment.
A client is ruminating over how much of a ‘klutz’ they are as they tripped over a curb during their first run with a new fitness group. The client bruised their knee but no permanent damage was done. The psychologist reviews the situation with the client and noted that the client describes the event as happening after they worked a 12-hour day and did not sleep well the night before. The psychologist is questionning and discussing the situation with the client to gain additional details of the event and situation. In this focus, the psychologist is attempting to:
A. Reframe the situation, so the client sees their tripping is due to their tiredness versus their being a ‘klutz’ through guided discovery.
B. De-personalise and reattribute the cause of the trip to it being dark and hard to see through guided discovery.
C. Explore how the client has come to self-define themselves as a ‘klutz’.
D. Attempting to moderate the client’s response to tripping by noting the lack of significant consequence to tripping and in essence de-catastrophising the event.
E. Identify the schemas on which the client has based the attribution of their accident.
A. is the most appropriate response. The psychologist is exploring the event with a focus on the client’s internal attribution, but instead of shifting the attribution to an external one, the pychologst is attemoting to help the client see the ‘trip’ as possible evidence of their being tired versus being a ‘klutz’. Thus, while this approach continues a focus on internal attribution the guided discovery is focused on a less ‘global’ and more changeable attribution.
A psychologist and client have been working together for 3 months, and during their fifth session, the psychologist has forgotten to turn off his mobile phone. Additionally, the psychologist has not turned off his laptop nor turned off the sound on the computer. As a result, the therapy session is disrupted by both a phone call and multiple email notifications before the therapist apologises and turns off all his personal electronic devices. Nevertheless, the client feels as though she is not being attended to appropriately as it reminds her of how she was ‘brushed aside’ by her parents as a teenager when they had to go to work. This is an example of:
A. Therapeutic rupture.
B. Inappropriate attending on the part of the therapist.
C. Client resistance.
D. Client re-enactment.
E. Client Projection.
B. is the most appropriate response. While it would have been better for the psychologist to have turned off their electronic devices prior to the session starting, after a therapeutic relationship has developed it would generally take more than a phone ringing to disrupt a focused session, and would be therefore inappropriate attending by the therapist.
A therapeutic relationship, or alliance, can be disrupted in a number of ways. If a specific client continuously attends sessions, but without completing their assigned ‘homework’ involving a thought record or an emotional response log, this is likely a sign of:
A. Therapeutic rupture.
B. Client resistance.
C. Client re-enactment.
D. Client ambivalence.
E. Indication that this client a pure behavioural approach will be best used, as the client is not interested in identifying their thoughts or feelings as evidenced by their lack of compliance with homework tasks.
B. is the most appropriate response. This most common difficulty found within a therapeutic relationship is client resistance and ambivalence. Clients often have a desire to change but also resistance to change. This can include a reactance to one’s personal freedom being seemingly threatened, reluctance, and ambivalence all serving to ‘slow’ the progress made in therapy. The preferred method for dealing with resistance is to openly and gently discuss the issues in the therapeutic relationship.
Case formulation or conceptualisation involves:
A. Conceptualising and discerning what the client’s core difficulties involved.
B. Different foci depending on the theoretical approach used.
C. Designing an appropriate treatment, which tends to result in better client outcomes.
D. B and C.
E. A, B, and C.
E. is the most appropriate response. Case conceptualisation or formulation is important for identifying client care difficulties, will include difference specifics based on the theory used, and is employed in treatment design and application.
In their first meeting, the client discusses with the psychologist his depressive symptoms and shares his belief that he is simply weak and personally lacking in coping ability, the economy is too slow to allow him any significant career progress, and he cannot see this situation changing any time soon given the state of the global economy. Which of the following approaches would best target the difficulties presented by the client?
A. A cognitive focus reviewing the client’s distorted thoughts, maladaptive assumptions, and dysfunctional schemas.
B. A supportive purely relational approach so he does not feel alone in his situation, after all the economy is not doing very well and it is difficult to find work.
C. A supportive atmosphere in which thoughtful questioning helps the client examine and then test his beliefs that could eventually be modified to be more adaptive.
D. A problem-solving approach involving a review of the client’s resume and work behaviours to help with career progression.
E. A mixture of both a supportive relational and problem-solving approach so the client does not feel alone in his situation and receives help with his career progressing.
A. is the most appropriate response. The client in this example is presenting with cognitions reminiscent of the negative triad (view of self, world and the future). The general steps in cognitive therapy include creating a supportive atmosphere, examining beliefs via Socratic dialogue, a testing of beliefs and assumptions, and then modifying assumptions via a guided discovery progress as many items may be outside the client’s awareness.
Termination refers to the process ending psychological services. Services can be ended in a more abrupt or rapid manner. Services can also be ended in a more gradual manner by, for example, extending the amount of time between sessions and discussing saying good-bye and ending services over the last few meetings.
Which is true for the termination of psychological services?
A. Termination is best when not abrupt as it can help consolidate treatment gains and troubleshoot likely future obstacles.
B. Clients will often cancel their last session because they do not wish to say goodbye.
C. A and B.
D. Clients will often avoid therapy endings by bringing up new issues for discussion in therapy, and thus termination is best when more rapid to avoid this bid to continue service.
E. It is best to inform the referring doctor prior to commencing termination.
C. is the most appropriate response. If on eplans for termination at the start of therapy, the nature of saying goodbye with clients can be managed for client benefit. This can include a consolidation of gains made in therapy, problem-solving difficulties that occur, and directly addressing goodbye events.
When discussing open and closed questions, it is important to note:
A. Open questions are better as they are likely to encourage client talk.
B. Closed questions are better as they are likely to provide specific information.
C. The questions asked need to be purposeful and lead to a greater understanding of the client.
D. Preparing questions in advance of the treatment session will ensure the correct questions are always asked.
E. Questions should be avoided as they can make the client feel interrogated.
C. is the most appropriate response. Questioning is a valid psychological tool for gaining client information. Both open and closed questions are appropriate given the intention of the psychologist involved. Questions are not asked out of mere curiosity.
A client is discussing a very disturbing emotional event with a psychologist. The client is highly emotive. Which of the following are likely to assist with the regulation of emotion?
A. Labelling the emotion.
B. Refocusing client attention relating to the event on the more natural aspects of the event.
C. Direct the client to break from discussing the event until the emotion settles.
D. Focus on solving the problem confronting the client.
E. A and B.
E. is the most appropriate response. Cognitive emotional regulation strategies include emotional labelling, distraction of attention (internal and external) to more neutral or positive aspects of a situation, and reappraisal of meaning via language, for example, saying something is more challenging versus troublesome.
A client is ruminating over how much of a ‘klutz’ they are as they tripped over a curb during their first run with a new fitness group. The client bruised their knee but no permanent damage was done. The psychologist reviews the situation with the client and notes that the client describes the event as happening at dusk when it was thus becoming dark and harder to see. The psychologist is questionning and discussing the situation with the client to gain additional details of the event and situation. In this focus, the psychologist is attempting to:
A. Reframe the situation, so the client sees their tripping is due to their tiredness versus their being a ‘klutz’ through guided discovery.
B. De-personalise and reattribute the cause of the trip to it being dark and hard to see through guided discovery.
C. Explore how the client has come to self-define themselves as a ‘klutz’.
D. Attempting to moderate the client’s response to tripping by noting the lack of significant consequence to tripping and in essence de-catastrophising the event.
E. Identify the schemas on which the client has based the attribution of their accident.
B. is the most appropriate response. The psychologist is exploring the event with a focus on personalisation and attempting to help the client reattribute the cause of the trip from being a ‘klutz’ to it being dark and therefore from an internal attribution to an external attribution.
Which of the following is an example of chain analysis?
A. A client is engaging in psychological support to aid in their management of diabetes. In discussion with their psychologist, a client notes and reflected back to them that the day before they were feeling low after having a disagreement with their partner, a mistake they made at work was pointed out to them by a colleague, they thought to themselves “I am no good at anything”, felt depressed and tired, and went home with a headache and spent the rest of the day viewing ‘junk’ television and eating ‘junk’ food and as a result feels even worse and has experienced dramatic increase in blood sugar levels.
B. In discussion with their psychologist, a client notes that when their boss calls a review meeting, they feel scared because at every review meeting the boss has held there has always been either a reduction in paid working hours for staff or staff redundancies.
C. In discussion with a psychologist, a parent identifies that when they are especially tired, they ‘give in’ to their child’s demands to stay up past their bedtime and that leads to their both being more tired the next day.
D. A and C.
E. A and B.
A. is the most appropriate response. A full chain analysis includes vulnerability factors; activating events; thoughts, feelings, and behaviours; as well as responses in a timeline fashion relating to a specific event.
Which of the following would be considered behavioural experiments?
A. Asking a client to ‘not think’ of a specific event at 9am and 9pm every day for a week.
B. Asking a client who is engaging in ‘counting by twos’ as a safety behaviour to forgo engaging in the behaviour on Tuesdays and Thursdays to see the result.
C. Asking a client who is concerned about becoming bald to identify how many bald people he sees in a week.
D. All of the above.
E. Only A and C.
D. is the most appropriate response. A behavioural experiment is any planner event, usually homework, that helps a client explore the validity of a belief or test out a new belief.
