Interventions Flashcards
1
Q
what are the 6 core counselling skills?
A
attending skills
basic questioning skills
confrontation
focusing
reflection of meaning
influencing skills
2
Q
What is attending skills and when is it used
A
encourages clients to talk
show’s interest
used throughout (particularly important in intials stages to build relationshiop)
examples: body language
3
Q
When is questioning useful
A
In the formation gathering stages and throughout
4
Q
what is the therapeutic alliance?
A
The establishment of a collaborative
relationship characterized by common goals and understanding.
5
Q
what do you do when clarifying client thoughts
A
(Reflecting and Paraphrasing)
If someone
tells you that her husband cheated on her and that her son stole
money from her don’t say “suck it up princess” or give her a
Freudian interpretation or tell her how you can’t trust people in
this world anymore and it also happened to you. Say something
like: “You have been hurt by your husband and also your son”
6
Q
what are the criteria for interventions? (4)
A
time limited
structured
have a beginning, middle, end
are specific to goals and outcomes
7
Q
what’s the evidence based interventions for PTSD
A
TF=-CBT
EMDR
prolonged exposure
psychodynamic
8
Q
You get referred someone because they have a driving phobia. And they were in car accident and can’t sit in drivers seat without getting anxious. What is most appropriate therapy to use in this situation?
- Cognitive restructuring
- Narrative therapy
- Graded exposure
- Imaginative exposure
- Motivational interviewoing
A
- Graded exposure
Imaginative exposure: exposure to symbolic representation of their fear.
9
Q
A 45-year-old woman is referred to a psychologist for treatment of spider phobia. The psychologist decides to use a form of exposure therapy. Which of the following exposure methods is likely to be most effective?
1. Graduated exposure and habituation to live spiders.
2. Graduated exposure and habituation to plastic spiders
3. Exposure and habituation using pictures of spiders.
4. Exposure and habituation of the response to live and plastic spiders
5. Graduated exposure and habituation using spiders and other insects.
A
- Graduated exposure and habituation to live spiders.
10
Q
what are the general concepts for any intervention question on NPE (5)
A
think about stages of treatment
meet client where they are at
start slow and gentle
start with validating and exploring
find common goals
11
Q
what are the 9 steps in the sequence of therapy?
A
- establish rapport
- explore concerns
- assessment
- diagnosis and formulation
- psycho education / socialisation to treatment
- develop treatment plan / goals with client
- Intervention
- Evaluate treatment
- closing: summarise / discharge / followup
12
Q
what are the evidence based treatments for depression?
A
CBT / IPT / brief psychodynamic therapy
13
Q
What is IPT and what 4 areas does it specifically focus on?
A
Interpersonal Therapy
grief and loss
interperonal disputes (depression in relation to conflict in relationship)
role transitions (adjustment problems; adolescence-adulthood, parenthood, aging, job, relationships)
Interpersonal sensitivities (depression with establishing or maintaining interpersonal relationships) Style of attachment that results in problems with interpersonal functioning.
14
Q
how does IPT work
A
delivers a structured and formulised treatment plan based on comprehensive assessments of clients attachment style.
15
Q
what is attachment theory?
A
how individuals form, maintain, develop and end relationships
16
Q
what conditions would you use IPT with
A
eating disorders
bipolar
substance abuse (not chronic)
anxiety
postnatal
suicide prevention
depression
17
Q
what conditions WOULDN’T you use IPT with (5)
A
chronic substance abuse
psychosis
sever cognitive deficits
personality disorders
acute suicide risk
18
Q
IPT : phase 1: how many sessions and what does it involve?
A
Phase 1: sessions 1-2
assessment diagnosis
interpersonal inventory
determine treatment focus
interpersonal formulation
treatment contract
19
Q
IPT: phase 2: how many sessions and components of sessions?
A
Phase 2: session 2-14
interventions:
clarification
communication analysis
clarifying interpersonal incidents
expressions of affect
role playing
homework
problem solving
20
Q
IPT: phase 3: how many session and components of sessions
A
Phase 3: session 15+
therapeutic review: with interpersonal inventory
anticipate future problem areas
maintenance contract.
21
Q
with IPT, what needs to be taken into account when assessing attachment? (4)
A
content of clients description of relationships
quality of client’s narrative: ability to describe dialogue, emotional content and non verbal information
description of other individuals
client / therapist relationship
22
Q
what factors are relevant when assessing for IPT suitability (4)
A
severity of illness (not suitable if severe)
motivation
therapeutic relationship
resilience (capacity to withstand internal or external stress)
23
Q
what is an interpersonal inventory in IPT
A
The interpersonal inventory is a brief description of the important people in the client‟s life. It documents the nature of the relationship, quality, expectations and problems.
purpose is to determine which relationships to work on and to gather further info on attachment style and communication patterns
used to develop and orient therapy
24
Q
You are seeing a new client 40 yr old man in first session, tells you doesn’t want to be seeing you, gp sent him, had an accident 2 yrs ago, now doing well and drive in local area, outside local area he gets wife to drive. He doesn’t see this is a problem. What is your next step:
1. Refer to OT to look at driving and advice driving skills
2. Start assessment of difficulties to drive outside local area
3. Develop graded exposure hierarchy for driving difficulties
4. Explore reasons for only driving in local area
5. Do assessment for ptsd.
A
- Explore reasons for only driving in local area
Need a soft start as he doesn’t want to be there. Need to explore before doing assessment. First build reapor, then explore, then assessment.
Never start with assessment. Look for words such as explore, validate, listening to client (especially those not keen to have treatment).
Answer is most often in the questions. Why did she bother to tell you that the guy doesn’t want to be there. There is the answer.
25
You are working with panic attack, after ended romantic relationship, now scared of panic attack. You decide to use cbt you want to do graded exp hierarchy and start by identifying triggers for panic attack, he becomes distressed and says this is making him anxious. What would be the next thing you would do?
1. Work with client to understand reasons for distress
2. Encourage be brave and face fears directly
3. Refer to gp for medication
4. Construct fear hierarchy about triggers
5. Don’t talk triggers as causing too much distress
1. Work with client to understand reasons for distress
26
Guy cannot drive, in an accident 9 mths ago, seriously injured, someone died (friend), has nightmares, intrusive thoughts, finding it very hard to drive. What intervention would you use?
1. Graded exposure related to fear of driving
2. Teaching strategies relaxation
3. Trauma focused cbt to help client process trauma history
4. Grief counselling over loss of friend
5. Trauma informed supportive counselling
3. Trauma focused cbt to help client process trauma history
Number 3 because he has symptoms of ptsd, therefore ptsd intervention.
27
Same guy as above, you do assessment and diagnosed ptsd and decided to use trauma focused cbt approach. What would be the next step:
1. Imaginative exposure to car crash memories
2. Psycho education linking symptoms to trauma experience
3. Teaching relaxation strategies to go back to driving
4. Doing in vivo exposure to driving
5. Start with supportive trauma informed counselling then trauma focused cbt
2. Psycho education linking symptoms to trauma experience
This is clearly a question about stages, you’ve done diagnosis and next step is to explain – psychoeducation.
Need to read questions and think about what they are asking. If you find anything like supportive counselling is not want they want. Disregard this option. There is no evidence this helps with ptsd.
28
You are seeing someone and during assessment they say have sig impacts of stress /anxiety when assaulted 3 yrs ago. Have flashbacks and avoids going out. You assess ptsd. Which strategies most effective?
1. Progressive muscle relaxation and invivo exp
2. Imaginative exp of cog restructuring
3. Progressive muscle and image exp
4. Progressive muscle cog restructuring
5. Progressive muscle relaxation and invivo exp
2. Imaginative exp of cog restructuring
Use PMR for GAD and sleep… is PMR is not an intervention to trauma. Because people are very sensitive to body sensations with ptsd. This is counter indicated with people with ptsd. Many can’t do visual exposure.
With ptsd questions need to look for a behavioural strategy and a cognitive strategy.
Why don’t you go graduated exposure for ptsd? As you can’t do in vivo exposure to trauma. You’re not going to put them in a car crash again.
There is some in vivo exposure in ptsd treatment with avoided situations. This comes after you have processed traumatic memories and when they don’t cause distress any more then do in vivo exposure to avoided situations.
29
what is TF-CBT
cognitive restructuring and imaginative exposure. This may be called prolonged exposure. This is another type that involves the same, imaginative exposure and cognitive restructuring
30
Doing some research on the most effective treatments for PTSD and you are just trying to find which one is evidence-based and which isn’t. you lit search and find one intervention not supported. Which one is it?
1. Prolonged exposure
2. Emdr
3. Tf cbt
4. Psychodynamic therapy
5. Thought field therapy
5. Thought field therapy
31
Seeing 30 yr old women, depressed, used to be socially active and used to do exercise. Now not doing anything. You decide to treat with cbt. What strategies would be helpful
1. PMR and cog restruct
2. Socratic questioning and graded exposure
3. Cog restruct and imaginative exposure
4. Behavioural activation and cog restruct
5. Supportive counselling and cog restruct
4. Behavioural activation and cog restruct
32
So now you decide to do behavioural activation plan with client. What is most important thing to include
1. Make sure full weekly plan activities
2. Making sure there are rewards for achievement
3. Make sure client identifies an achievable schedule of activities
4. Make sure client sets consequence for not complying
5. Make sure you prepare client by teacher her regular relaxation before activites.
3. Make sure client identifies an achievable schedule of activities
Behavioural activation is the reward. A sense of mastery. Socialising with friends, feeling better after a walk etc. we’re not 5 any more, we can go buy a bar of chocolate. Outcome of activity is the reward!
Most important thing when developing a behavioural activity chart is it needs to be achievable and realistic!!!!
Don’t set clients up for failure. SMART goals.
33
Seeing 25 yr old, has 3 boys under the age of 6. Referred from gp. Scored 38 on K10. She’s teary and feels guilty about not being good mother, and guilty about everything. You decide she probably has depression. What is the most important next step?
1. Identify the difficulties of being mother 3 young kids
2. Start with behavioural activitation schedule
3. Listen to client and validate feelings and concerns
4. Assesss her capacity to care for children
5. Assess clients need for medication.
3. Listen to client and validate feelings and concerns
34
Depression. Client not progressing. Done 10 sessions. What do you do next?
1. Do another round cbt
2. Exposure therapy
3. Rogiean therapy
4. Emdr
5. Interpersonal therapy.
5. Interpersonal therapy.
For the board, level 1 evidence for depression are cbt and ipt.
For the board: if cbt doesn’t work then they want you to do interpersonal therapy.
35
what is the biopsychosocial model with IPT
The Biopsychosocial Model suggests that attachment and interpersonal behaviour is shaped by:
Genetic predisposition (to emotional health problems)
Social factors (current supports available, or ability to enlist support of others)
Psychological development (temperament, personality, ability to cope with stress /
adapt to change)
people who attribute problems to interpersonal things.
36
what are the techiques of IPT?
1. clarification questions
2. expression of affect / emotional regulation
3. communication analysis
4. clarifying IP incidents
5. problem solving
6. role playing
7. use of therapeutic relationship
8. homework
37
what is communication analysis in IPT
Communication analysis is simply a formal means of investigating the hypothesis that the client‟s difficulties are being caused, perpetuated or exacerbated by poor communication.
Hence the goals of CA are to:
* Help the client identify his/her own communication patterns
* Help the client recognise his/her contribution to the communication problem
* Motivate the client to communicate more effectively
38
Client, long history of headaches, had medical assessments and can’t find anything, gp thinks psychological component, has history of neglect and lost, difficulties with regulating her emotions, when you talk to about identifying triggers for headaches she says that she can’t identify emotions.. Which therapeudic approach
1. Approach t be more interpersonally effective
2. Approach to put feelings and emotions into words
3. Approach includes systematic desn
4. Approach treatment with medicat
5. Approach to help client feel motivated to change behaviour
2. Approach to put feelings and emotions into words
39
You’re an ipt therapist and seeing client, 1st session client says I really like talking to you and I wish therapy would never end. How would you address development of transference
‘1. Address the transference as it's an active target of IPT
2. ignore comment as it’s not an active target of IPT
3. focus on interpersonal functioning as ipt considers more important than transference.
4. let transference develop over time as hallmark of ipt
5. Address transference straight away so problem isn’t repeated in therapy
3. focus on interpersonal functioning as ipt considers more important than transference.
Transference is not an active component of IPT. IPT is the here and now!!!! What he said is not a problem, can be used as information / material. We will address the comments but not as transferrece
40
With client, middle of therapy, he’s talking about conflict with daughter so you address interpersonal conflict. What strategies would you use?
1) Thought monitoring and challenging of distortions
2) Problem-solving and communication analysis
3) Free association and interpretation of transference
4) Emotion regulation and distress tolerance
(5) Pleasant event scheduling with daughter, distraction when focnlict
2) Problem-solving and communication analysis (ipt)
1) Thought monitoring and challenging of distortions (this is cbt)
2) Problem-solving and communication analysis (ipt)
3) Free association and interpretation of transference (this is psychodynamic)
4) Emotion regulation and distress tolerance (dbt)
(5) Pleasant event scheduling with daughter, distraction when focnlict (cbt)
41
Treating client using IPT and you’re asking them to describe relationship conflict in the past few weeks. What is the main reason to ask this?
1. To assess cognitive schema
2. Assess clients individual style
3. Assess clients cog distortions
4. Assess clients attachment style
5. Asses clients genetic predispition to emotions.
4. Assess clients attachment style
42
Doing IPT / at session 12 and realise you will have to extend treatment to achieve goals. What is the most important thing to consider?
1. Give enough time for client to process experiences of past loss
2. You don’t need to extend for a 2nd time
3. That the focus remains on current symptoms and problems
4. Grief of termination doesn’t take over content of sessions
5. That you fully deal with any transference feelings before finishing therapy.
3. That the focus remains on current symptoms and problems
The board would want you to look at not changing the focus here, not the extension duration.
When the board is asking about treatment, they are asking about treatment plan and goals. This is the focus.
43
what is MI (motivational interviewing)
MI is a collaborative conversation style for strengthening person’s own motivation to change.
person centred, goal oriented, trying to illicit clients internal motivation to change. With questions stay with things about client wanting to change, reasons to change etc. AOD counselling (developed from)
44
what is the main goal of MI
The main goal of MI is to increase the clients’
readiness to change and to help them plan for,
make, and maintain that change
45
what are the 4 principles of MI
Resist the righting reflect
understand clients motivation: MI takes the position that motivation comes from within the client. That is, we do not motivate client or install motivation in them, rather we find the motivation that lies within them and help them to recognise it
.
listen to client
empower client
46
what is the sequence of therapy in general
1.Establish rapport and/or therapeutic relationship
2.Explore concerns
3.Assessment
4.Diagnosis and formulation
5.Psycho-education, socialization to treatment.
6.Develop treatment plan with client (goals, consent, planning)
7.Intervention (cognitive, behavioural, relationship analysis, expression of affect, problem solving, etc)
8.Evaluate treatment
9.Closing: Summarise/consolidate/relapse prevention/discharge/link with other services/follow up
47
what treatments are evidence based for depression
CBT
IPT
brief psychodynamic therapy
48
what treatments are evidence based for anxiety
CBT
48
what treatments are evidence based for anxiety
CBT
49
what treatments are evidence based for personality disorders
psychodynamic
DBT
schema therapy
50
what treatments are evidence based for PTSD
TF-CBT
EMDR
prolonged exposure
psychodynamic
51
what treatments are evidence based for AOD
CBT
motivational interviewing
52
what treatments are evidence based for adolescent / child emotional and behavioural difficulties
Family therapy
53
what treatments are evidence based for ADHD
parent management training.
54
CBT is first line of treatment for what disorders
anxiety
phobias
panic
PTSD
depression
always think 2 elements to CBT: cognitive and behavioural
55
steps for CBT challenging thoughts
1. define situation
2. Clarify meaning of cognitive appraisal
* What was going through your mind just then?
* What did the situation mean for you?
3.Evaluate interpretation
* Evidence: For and against this belief?
* Alternatives:Any other explanation(s)?
* Implications: So what….?
56
what does exposure therapy involve?
involves systematic, repeated, and prolonged presentation of objects, situations, or stimuli (either internal or external)
57
what are the 3 types of exposure used for fear reduction
Situational (in vivo)
* Involves contact with physical objects or actual situations that are avoided in the external environment
Imaginal: Involves presentation of symbolic fear stimuli
Internal/interoceptive: Self-focused; involves exposure to feared physical sensations
Most therapists conduct exposure in a graduated fashion guided by an exposure hierarchy. Often called systematic desensitisation.
58
what is bahavioural activation
One of the most important goals for depressed patients is increasing their activity
levels. Most have withdrawn from at least some activities that had previously given them a sense of achievement or pleasure and lifted mood.
BA includes the re-establishment of routines as well as the establishment of new (desirable and positively) reinforcing behaviours
* New behaviours are difficult to establish initially, so focus on pre-depression routines to begin with (e.g activities the person engaged in prior to being depressed that they have ceased doing now)
* Start with small, achievable goals. Work collaboratively with client to make a plan.
59
CBT for anxiety: what to do?
start with cognitive interventions and then exposure
60
CBT for depression, what to start with?
start with behavioural activation as this usually improves mood
61
CBT for panic, what to start with?
cognitive interventions and then graded exposure including, imaginal, in vivo and interoceptive
62
CBT for OCD: what to start with?
cognitive interventions and then graded exposure and response prevention
63
CBT for PTSD (TF-CBT): what to start with?
cognitive interventions and imaginal exposure for traumatic memories
64
What four elements are the underlying spirit of MI
Partnership
acceptance: respecting client's worth and potential, and honouring client's autonomy
Compassion:
Evocation: role of psychologist is to evoke / draw out clients own intrinsic motivation for change.
65
Solution focused therapy (SFT). what are the 2 goals
get clients to explore:
1. what they want different in their lives (goals)
2. what strengths and resources they can bring to bear on making these differences.
conversations focus on building solutions rather than solving problems
66
SFT: key criteria
find clients streghts and resources with then
therapist's job is the identify and amplify change
don't really need to know much about the complaint
not necessary to know cause or function of complaint
a small change is all that is necessary
therapy is future and solution focused
67
what types of questions are used in SFT (5)
goal setting
miracle questions
exception questions
coping questions
scaling questions
68
what is the main goal of MI if the board asks?
helping the client find internal motivation
69
Working with young male, referred by gp for alcohol, he’s not convinced drinking is a problem, after 3 sessions he is ready to work with setting some therapeutic goals. Most important next step?
1. Ask the client to keep behavioural record of drinking to reduce resistance
2. Send client back to gp to treat any other health issues
3. Increase clients self efficacy to work on a plan for change
4. Instruct client on different self efficacy methods
5. Teach client a number of different strategies to reduce drinking.
3. Increase clients self efficacy to work on a plan for change
Buzz words are always self efficacy, agency, collaboration, intrinsic motivation, internal motivation, rolling with resistance, acknowledge difficulties with change, compassion, acceptance.
For this type of questions, look for buzz words.
70
Woman wants to stop smoking. What is key aspect of MI?
1. Help identify and act on motivation
2. Provide client advice on pro and con of change
3. Challenging clients view of being incapable of change
4. Provide strategies to move from pre cont. to cont.
5. Challenging clients dissonance between motivation and action.
1. Help identify and act on motivation
This client is getting ready for action, she’s ready to change. She’s not in pre contemplation.
71
Working with an athlete that has performance anxiety. 14 yrs. Been approached by aust inst sport to work in elite sports program. She’s excited about it, working towards this, has noticed since that she’s been making mistakes, avoiding practice sessions, thoughts of not measuring up and being an imposter. Best strategie to address performance anxiety?
1. Cog restructuring and imagine exposure
2. Mi and goal setting
3. Goal setting and prob solving
4. Relax training and skill rehearsal
5. Supportive counselling and assertiveness training.
1. Cog restructuring and imagine exposure
With anxiety you think CBT. With CBT you need 2 components. Cog and behavioural.
72
Treating 65 yr with social anxiety. Asking them to identify their thoughts in social situations. Tells you they can’t identify, mind goes blank. Best option with proceeding?
1. Refer to gp for memory problems
2. Engage client in motivation interviewing process to help him get over avoidance of thoughts
3. Review case formulation to get more info
4. Provide reference event of specific even to help explore thoughts
5. Stop doing cog restruck as client can’t access thoughts.
4. Provide reference event of specific even to help explore thoughts
73
psychodynamic therapy has 7 key features. What are they?
focus on affect and expression of emotion
exploration of attempts to avoid distressing thoughts and feelings
identification of recurring themes/ patterns
discussion of past experience
focus on interpersonal relations
focus on therapy relationship
exploration of fantasy life
74
What is stress inoculation training?
a form of cognitive restructuring.
aim is to change the emotional responses and behaviour before the person becomes very anxious / depressed as a result of stress.
75
what are the 3 stages of stress inoculation training
conceptualisation: identify stressors
skill acquisition and rehearsal: practice positive coping statments
application and follow through: person begins to apply the skills in vivo
76
what are buzz words for motivational interviewing
intrinsic motivation, rolling with resistance, self-efficacy, exploring resistance, collaboration
the board will usually state the approach you are using and you need to find the buzz words in the answer
77
what are solution focused therapy buzz words
: future oriented, preferred future, miracle questions, future goal, goal oriented, past successes; exceptions (ie when the problem was not there)
78
what is the goal of solution focused therapy
It’s about what a person wants different in their life. What can they do and what strengths do they have to help this.
Doesn’t explore reasons for problem (like in the past) – it goes into the past to look for exceptions (like when the problem wasn’t there). What was happening when this was not a problem . u
79
Q. Client tells you they are very stressed and wife has been asking him to change things for a few years and is now leaving, he is surprised and distressed and doesn’t want her to leave. Using SFT what is next step?:
1. Start treatment to change behaviour
2. Give psycho-ed re relationships
3. Discuss his preferred future with his wife
4. Ask him to bring wife in for couples therapy
5. Try to elicit intrinsic motivation to change
3. Discuss his preferred future with his wife
80
We ask a person the miracle questions. The miracle question is:
1. See how well the client is coping
2. Scale the problem and motivation for change
3. Understand causes of what’s been going wrong
4. Allows client therapist to agree on the future client would prefer
5. Allows you to determine exceptions to the problem
4. Allows client therapist to agree on the future client would prefer
The miracle questions is like the start of the conversation. You can then use the answer to ask and explore further.
81
Seeing a guy, lost job, feeling low, doesn’t know what he wants to do in the future. Nervous about career options. Decide to use problem solving approach. What would it involve
1. Picture preferred career outcome
2. Do vocational assessment
3. Brain storm alternative solutions to improve confidence
4. Do some cognitive restructuring to improve motivation
5. Systematically generate a number of options and analyse possible career paths.
5. Systematically generate a number of options and analyse possible career paths.
3 is a mix of possible and stupid (read the Q and answers carefully)
2 options that are possible. If you flag this and come back to it how do you choose. Look for anything that could be spoiling the answer – improve confidence? How?
5 is the best option
This is an example of naughty, tricky question. Option 3 – how is it going to improve confidence. Watch out for question where first half of the answer is it ‘could be’ and then they spoil it. Brain storming options will not improve confidence.
Need to read questions and think about which one makes sense.
When looking at options of questions, like if there are 2 possible answers, look for things in the answer that are going to SPOIL the answer. Like improve confidence.
82
What is family therapy and what does it focus on
targets interpersonal issues based on relationships family's have inside the system. IT'S NOT INDIVIDUAL.
it's psychopathology as an interpersonal issue.
no psychoeducation
no individual therapy in front of an audience
not doing behavioural management
83
what are the buzz words to look out for in family therapy
boundaries / roles of members in family / function of behaviour / patterns of relationships / Interventions usually focus on boundaries,
function of behaviour in the system,
structure of the family, patterns of
relationships and communication patterns.
84
Family therapist, seeing father with 3 teenage girls, they argue, yell all the time, always fighting. Decide to use family systems approach. Would would be main focus:
1. Patterns of behaviour within system
2. Motivation of each member to improve relationships
3. Psychopathology with any members in the family
4. Who has power in the family
5. Which member can be allie to improve relationships
1. Patterns of behaviour within system
4 seems to be an individual type of intervention. Once you know who has power in relationship where would you then go with that? It would be focusing on that individual. Not family therapy.
85
Talking to family, you’re a systems family therapist, 20 years experience, have problem with 12 yr old son. Getting in trouble because he’s been shoplifting, he had older brother who passed away in car accident 1 yr ago. Main focus of intervention:
1. Parenting strategies to help parents set limits with son
2. Try to understand the function of the boys shoplifting behaviour within family system
3. Psychoeducation regarding responses after loss
4. Support family to process grief and loss
5. Work with boy with thoughts and feelings regarding loss of borther .
2. Try to understand the function of the boys shoplifting behaviour within family system
The family is not there to process on grief and loss. They are there because of child stealing. The answer is in the question! Ie if you go to gp because knee hurts and the gp treats shoulder.
Family therapy is not grief therapy.
86
You are a family therapist. Seeing a family with a 14yo who has an eating disorder. She is not eating enough. GP referral. GP describes family as “enmeshed”. GP describes mother and daughter are very overly close and enmeshed relationship. GP says mother confides with daughter and speaks for the daughter too much. As a family therapist, how do you address the emotional enmeshment in therapy? 1. Address family cohesion by strengthening alliances within the family 2. Address the teen eating behaviour with psychoeducation 3. Encourage the teen individuation by defining boundaries in the family 4. Encourage adolescent individuation and developing insight into system by facilitating self understanding in the adolescent 5. Promote adolescent individuation by expressing rebelliousness
3. Encourage the teen individuation by defining boundaries in the family
We want individual outcomes for daughter, but intervention we use is not individual – it’s family interventions.
No. 4 would be an individual intervention with an audience.
Can’t be intrapersonal (within self / mind)
87
what does psychodynamic theory focus on
how past experiences impact current relationships and experiences
the past lives in the present
88
You’re seeing a woman, long term difficulties with depression and relationships. Client asks what psychodynamic therapy will do?
1. Gradually face fear situations
2. Stop problematic behaviours
3. Help to explore thoughts connected to depression and challenge them
4. Explain PT will explore current relational themes and relate them to past experiences
5. Involve questions and pleasant event scheduling.
4. Explain PT will explore current relational themes and relate them to past experiences
89
what is transference
client’s emotional reaction to therapist. Feel certain things towards you that they couldn’t feel towards others. Based on earlier relationships. It’s not a crush.
90
what is countertransference
Countertransference is the way therapist feels abou the client, based on past relationships.
91
Social anxiety, homework task of dysfunctional thought record, you give guidance on how they can use do more effectively. Then doesn’t do any more worksheets.
1. Negatively reinforced for not completing homework
2. Displaying transference and therefore not completing tasks.
3. Client is passive-aggressive and is triggered by comments about thought record
4. Client has personality disorder and displaying resistance to CBT
5. Client is avoiding homework tasks because he is afraid negative evaluation.
5. Client is avoiding homework tasks because he is afraid negative evaluation.
92
is questions talk about medication ssri's - what is the most likely diagnosis?
depression
93
what medications would the board be talking about with bipolar
lithiam
any drug ending with 'ate'
mood stabiliser
94
what classification is the medication Lovan
SSRI
95
what classification is the medication zoloft
SSRI
96
what classification is the medication lexapro
SSRI
97
what is olanzapine used for
psychosis
98
what is clozapine used for
psychosis
99
what is risperidone used for
psychosis
100
what is ritalin used for
ADHD
101
what's another name for methylphenidate
ritalin
102
what class drug is valium
benzodiazepine
103
what class druge is xanax
benxo
104
what are beno's used for
panic, anxiety
105
Client. Tells you that they have been taking more and more Valium. Increasing the dose to cope with stress at home and work. Been doing so for 1m. What do you do? 1. Refer to Benzo withdrawal and detox 2. Tell them to stop taking the drug 3. Refer to drug and alcohol TX facility 4. Tell them to talk to GP 5. Start psychological TX for substance addiction
4. Tell them to talk to GP
106
Asked to evaluate outcome of interventions about bullying in high school. Which is the most appropriate way to measure the effectiveness of program
1. Change of scores in the Connors 4 for teachers over time
2. Number of bullying incidents pre and post intervention
3. Change of scores beck youth inventory
4. CBCL youth scores pre and post
5. SDQ pre and post
2. Number of bullying incidents pre and post intervention
The other options don’t look at bullying. Measuring target problem which is bullying.
107
Evaluate effectiveness of 10 week stress management program for a group. Want to track for each client individually. Ask client to track each week from 1 – 100. What method would you use analyse for each client
1. Linear regression
2. Factor analysis
3. Quadratic function of each score
4. Frequency of each rating
5. Plots of progress over time
5. Plots of progress over time
Research type of questions: if it doesn’t make sense then it’s probably not the answer. You are trying to look at how well stress management program is going.
Keep it simple! It will be about things you will use in your practice.
108
Working for big company. Doing observation on group activity to select people for specific role. They are doing problem solving exercise. You need to evaluate participant performance against a set of behavioural criteria. How should you rate performance?
1. Observe candidates solving problem
2. Observe how they interact with each other
3. Observe how they show team building skills
4. Observe how they display target behaviours
5. Observe how they respond to questions by team leaders
4. Observe how they display target behaviours
109
Seeing 12 yr old, trouble attending school and social activities. Diagnose with social anxiety and start intervention focusing on cognition and avoidance (CBT) with graded exposure. What is best method to assess progress in treatment?
1. Ask teacher to report childs progress after each session
2. Use relevant client self report each session
3. Ask family to fill out measure of client satisfaction end of each
4. Observe client at school after treatment
5. Ask parent to verbally tell you at end of treatment
2. Use relevant client self report each session
If words ‘progress in treatment’ are used need to think about measuring progress.
If you see word progress in exam, look for something that measures change over time!!!!
It’s improvement over seasons, not at the end
110
You are doing a literature review for your workplace. You find a number of meta analyses for a particular intervention. What is the strength of findings derived from meta analysis? 1. They allow for making a synthesis of independent studies 2. They are powerful studies based on a large number of participants 3. They provide a valid benchmark for efficacy 4. They present more valid methods than single case study 5. They allow you to make choices based on calculating attainment of goals
3. They provide a valid benchmark for efficacy
Meta analysis will give you an effect size. You can compare with other interventions.
You can compare efficacy of interventions.
111
Seeing client, has complex prevention and you use combination of treatments and make up your own home brew. You design treatment plan and use single-subject design to evaluate. What is the most important application of single subject design.
1. Valid and reliable assessment effects of treatment
2. Allows for evaluation of interventions without matched sample
3. Similar to case study and involve same type of analysis
4. Relevant to CBT
5. Not as scientifically rigorous as group methods.
2. Allows for evaluation of interventions without matched sample
You would use single subject design when you don’t have control group. When you only have one person.
112
ABA design with client. Depression. Outcomes of TX. Client is also taking medication. You are using ABA design and by the end of TX the client has made improvement in scores for depression. What can you conclude if using ABA single subject design? 1. The TX supplemented the meds for good outcomes 2. The medications supplemented the TX for good outcomes 3. Cant conclude anything 4. Both the TX and medication have possibly contributed to good outcomes 5. Bahamas
4. Both the TX and medication have possibly contributed to good outcomes
ABA is single subject design
With answers 1 and 2, if they are equally good, then they are equally bad!
113
Treating depression, use CBT and use depressed mood as target of treatment. Measure progress of target during treatment. Best way to measure progress ?
1. Measure at stochastic intervals
2. Measure at times of minimum compliance
3. Measure by progressive indices
4. Measure behaviour at frequent intervals
5. Measure at random intermittent intervals.
4. Measure behaviour at frequent intervals
If you have no idea what something means, it’s not the answer!
114
What’s most important thing to consider when choosing intervention program
1. Budget
2. Willingness of families to come to program
3. Room that you have
4. Research on efficacy of program
5. Norms by age and gender
4. Research on efficacy of program
ALWAYS LOOK AT EFFICACY FIRST
Choose efficacy by effect size.
115
If you have 2 interventions with similar effect sizes, one .4 and one .6 for BPD. One with lower effect size has more studies. Which would you use ?
1. Effect size 2. Participant size 3. Effect size and preference of client 4. Effect size and preference of therapist and client 5. Bahamas take into account all three. Choose the intervention client likes.
4. Effect size and preference of therapist and client
If you have to choose between effect size and no. of studies you would choose effect size.
116
See 16yr old, comes with mum. Gp says she is stressed about studies, difficulty sleeping, comes to appt and wants mum in. mum says girl didn’t want to come. Doesn’t know how it’s going to help. Doesn’t make eye contact at first. What’s priority?
1. Give girl questionnaires for forumulatin and diagnosis
2. Ask what is something she thinks she could get ou t of this
3. Psychoed on anxiety and sleep
4. Talk to mum and get developmental history first (girl wait in waiting room)
5. Tell her she’ll feel better with progressive muscle relaxation
2. Ask what is something she thinks she could get ou t of this
117
16yr old, comes with mum, mum says she is getting more withdrawin, avoiding social situations, academic performance has declined. Daughter tells you avoiding social without alcohol. Anxious. You have formulation and diagnosis. Can’t go out unless she drinks.
1. Start treatment mum and daughter on anxiety
2. Harm minimisation strategies
3. Give daughter psychoeducation on role of avoidance social anxiety
4. Contact school for academic performance
5. Refer drug alcohol service for treatment
3. Give daughter psychoeducation on role of avoidance social anxiety
118
You work in a PTSD response / trauma response in businesses. Providing staff support. Staff were present, working in a bank during armed robbery 2 days ago. You interview staff individually. Some of the staff report traumatic stress symptoms. What is the best approach for supporting staff? 1. Refer staff with symptoms for specialist PTSD TX 2. Book the staff with you and provide an evidence based PTSD TX 3. Follow up all staff for 1m for ongoing traumatic stress symptoms 4. Bring all staff together and provide psychological debriefing for critical incidents 5. Prolonged exposure therapy CBT for all staff with symptoms
3. Follow up all staff for 1m for ongoing traumatic stress symptoms
119
35yr old. Referred by gp for mdd. Married. 3 kids. First interview most issues connect to stress due to relationship with husband around different parenting styles. She agrees. Next step/
1. Refer client to parenting group program
2. Refer client to couples therapy
3. Start doing couples therapy
4. Give psychoeducation about parenting styles and how they can cause conflict
5. Contact clients husband.
4. Give psychoeducation about parenting styles and how they can cause conflict
How would you choose between 1,2,3? She also came to see you alone. Next stage in therapy sequence is psychoeducation.
120
WAIS: which subtests are the ones where all the items must be administered?
Symbol search, coding, cancellation
121
WAIS: What tests are not administered for individuals over the age of 70?
Letter–Number Sequencing, Figure Weights, and Cancellation
o Motor co-ordination, memory
o Normal deterioartion
122
WAIS: What subtests can you substitute with Comprehension?
Similarities, vocabulary, information
123
WAIS: What subtests can you substitute with Letter Number Sequencing?
digit span, arithmetic
124
WAIS: Which subtests can you use if one of the PRI index subtests is spoiled?
figure weights, picture completion
125
WAIS: What subtest should you use to substitute for Symbol Search and Coding?
cancellation
