Level 3 Exam Flashcards
What constitutes an Excellent score on the section of the test entitled “Testing: Review of BMS (pre-session) from current session”?
- The therapist displays and interested, warm, open demeanor when asking about BMS
- Reviews specific scores from each symptom section in meaningful way.
- Asks questions about scores/invites patient to discuss symptoms further
What constitutes an Excellent score on the section of the test entitled “Testing: Review of BMS and Evaluation of Therapy form from previous session”?
- The therapist comments on any pre-post symptom changes on last-session’s BMS
- Comments in an interested/non-defensive manner on Evaluation of Therapy Form
- Invites the patient to discuss symptoms changes and/or Evaluation of Therapy Form
- Shows genuine interest in connecting with patient about this information
What constitutes an Excellent score on the section of the test entitled “Empathy: 5 SECRETS OF EFFECTIVE COMMUNICATION w/ ANGRY PT”?
- Successful use of each of the 5 secrets: TE/FE, DA, ST, IF, IN
- Appears comfortable with difficult or sensitive topics
- Puts the patient at ease with use of 5 secrets
What constitutes an Excellent score on the section of the test entitled “Empathy: 5 SECRETS OF EFFECTIVE COMMUNICATION WHEN PT IS PRESENTING PROBLEM AND WHENEVER NECESSARY DURING SESSION”?
a) Successful use of many of the 5 secrets when patient is presenting problem
b) Appears comfortable offering extra empathy when needed/does not rush patient
c) Puts the patient at ease with use of empathy d) Overall excellent listening and reflection skills (TE/FE/DA)
What constitutes an Excellent score on the section of the test entitled “Agenda Setting: Invitation”?
a) Offers invitation to begin working on problem(s) while sitting with open hands and clearly open to continued empathy only.
b) Moves smoothly to empathy when patient exhibits resistance to agenda setting or to specificity when invitation is accepted.
What constitutes an Excellent score on the section of the test entitled “Agenda Setting: Specificity and Conceptualization”?
a) Therapist asks pt to describe a specific moment in time/place when s/he was struggling with specified problem.
b) Clear explanation of need for specificity is provided.
c) Conceptualization is clear and logical, helpful in guiding treatment
What constitutes and Excellent score on the section of the test entitled “Empathy: Assessing/Addressing Outcome Resistance”?
a) Mastery level of paradoxical magic button and magic dial questions used.
b) Clear paradoxical presentation and discussion of outcome resistance following presentation of magic button and before use of magic dial.
What constitutes and Excellent score on the section of the test entitled”Methods: Choice of Methods (Use of Recovery Circle/Intro to Failing as Fast as we Can)?
a) Generates 15+ appropriate techniques on a Recovery Circle (with minimal or no reliance on the List of 50 Techniques).
b) Demonstrates clear explanation of the purpose of the Recovery Circle to client.
c) Chooses methods squarely applicable to specific problem.
d) Demonstrates comprehensive understanding of all methods chosen.
What constitutes and Excellent score on the section of the test entitled”Methods: Presentation and Demonstration of A Few Methods - First Method Chosen by Examinee?
a) Thorough ability to explain the purpose of the method.
b) Strong ability to execute the method.
c) Incorporates appropriate empathy and connection.
d) Thoroughly integrates client learning at the end of the method.
What constitutes and Excellent score on the section of the test entitled”Methods: Presentation and Demonstration of A Few Methods - Second Method Chosen by Examiner?
a) Thorough ability to explain the purpose of the method.
b) Strong ability to execute the method.
c) Incorporates appropriate empathy and connection.
d) Thoroughly integrates client learning at the end of the method.
What is the setup for the Feared Fantasy Technique?
- Like the Externalization of Voices, this is a two-person technique. You and the other person act out your worst fears, such as being rejected because you aren’t smart enough or good enough. When you face your worst fear, you often gain liberation from it.
- Your worst fears usually don’t turn out to be real monsters, but figments of your imagination that can be defeated with a little logic, compassion, and common sense.
- It is a form of cognitive interpersonal exposure, and designed for interpersonal situations that someone is not likely to confront in reality.
- Patient are invited to enter into a Twilight-Zone world where their worst fears actually spring to life.
- In this world, if you think people are looking down at you, they really are - their thoughts about you are even worse than you would imagine
- People in this world also tell you what they are thinking, no matter how cruel or brutal it may sound.
- One person plays a “character from hell,” some judgmental or critical person the patient is afraid of who tries to rip the other to shreds based on their worst fears.
- The other plays the role of the client.
- After a while ask the client: Who’s being the bigger jerk here?
- Once the patient gets it, you can do a role-reversal, so she or he can do battle with the monster. This will convert intellectual understanding into real change at the gut level.
- In the end, make sure that any insights or positive thoughts it generates are written down in the Daily Mood Log.
What is the rationale and setup for the Acceptance Paradox?
- The Acceptance Paradox represents the spiritual core of CBT. It can lead to emotional enlightenment, but it’s the most difficult technique for patients and therapists alike to comprehend.
- When you use the Acceptance Paradox, you surrender to your own inner critic.
- It is similar to the Disarming Technique in the Five Secrets
- The Acceptance Paradox is an exception to the rule of moving on to the next technique if this doesn’t work.. If the patient doesn’t see it, you can continue to model it, using frequent role-reversals.
- It can be done in a role-play format like Externalization of Voices, with the emphasis being on the Acceptance Paradigm as opposed to the Self-Defense Paradigm.
- As always, any positive thoughts that are generated can be put back in the Daily Mood Log.
What is the rationale and setup for the Individual Downward Arrow Technique?
- The Individual Downward Arrow helps patients pinpoint Individual SDBs.
- You ask the patient to select a negative thought on his or her Daily Mood Log and draw a downward arrow underneath it.
- The arrow is a form of shorthand for this type of question: “If this were true, why would it be upsetting to you? What would it mean to you?”
- These questions will trigger a new negative thought that the patient can record directly under the arrow.
- Then you repeat the questions, and the patient will come up with another negative thought.
- Once you’ve done this several times, you can review the list of negative thoughts the patient generated. It will usually
be easy to identify the SDBs at the core of the patient’s suffering. - It is no so much of a method as it is a data-gathering technique.
- You’ve usually completed the Downward Arrow chain when you encounter a thought like one of these: a) That would mean I was worthless; b) That would mean life was not worth livi;ng; and c) Then I could never feel happy again.
- Keep a copy of this Self-Defeating Beliefs List, and hand it to the patient at this point. Patients are usually intrigued by
what we come up with. - Once you’ve identified an SDB, it can be helpful to do an Attitude Cost-Benefit Analysis (CBA).
What do I say in Straightforward Agenda Setting?
I would say something like this: “John, you’ve mentioned a number of very difficult problems that you have been struggling with, including X, Y, and Z. I’d like to offer you more than just listening and support, as important as that is. I have a number of powerful tools that I believe could help you tremendously. As such, I’m wondering if this would be a good time for us to roll up our sleeves and get to work on one of the problems you’ve described, or if you need more time to talk and have me listen. Listening is important, and I don’t want to jump in prematurely, before you feel ready.”
What do I say when I’m doing Paradoxical Agenda Setting?
“Mary, you’ve been telling me how frustrated you feel with _________. You’ve mentioned how difficult he /she is to deal with, and so forth. I’m wondering if you want some help with your relationship with this person, or if you mainly just wanted to let me know how difficult and annoying he or she is.”
What are the Truth-Based Techniques?
They are:
a) Examine the Evidence
b) Experimental Technique
c) Survey Method
d) Reattribution
What are the Logic-Based Techniques?
They are:
a) Socratic Method
b) Thinking in Shades of Gray
c) Process vs. Outcome
What are the Semantic Techniques?
These are;
1) Semantic Method
2) Let’s Define Terms;
3) Be Specific
What is Empathy, and why is it important?
When we’re upset, you need someone to listen and see the world through your eyes without trying to cheer us up, change us, help us, or give us advice. Although this usually won’t cure us, it’s often a necessary first step. It can be a tremendous relief to feel that someone’s listening.Similarly, we can empathize when you’re trying to help a friend or family member who feels upset. Usually, all they really want is for us to be a good listener.
What is Agenda Setting, and what is its purpose?
Agenda Setting is the most basic and important technique of all. First, try to define a specific problem you want help with. It must be specific as to person, place, and time.
Ask yourself, “What is the specific problem I want help with? What time of day did it happen? Where was I? Who was I interacting with? What was going on?”
Second, ask yourself if you’re motivated and willing to roll up your sleeves and work on it now, rather than just talking about it endlessly. Ask yourself, “What would it be worth to me to solve this problem? How hard would I be willing to work on the solution?”
What is the Straightforward Technique?
You try to substitute a more positive and realistic thought for each of your Negative Thoughts. Ask yourself, “Is this Negative Thought really true? Do I really believe it? Is there another way to look at the situation?”
What is the Experimental Technique?
You do an experiment to test the validity of your Negative Thought, in much the same way that a scientist would test a theory. Ask yourself, “How could I test this Negative Thought to find out if it’s really valid?”
What is the Survey Technique?
You do a survey to find out if your thoughts are realistic. Ask yourself, “How do other people think and feel about this? Could I ask some friends about this to get some feedback?” For example, if you believe that social anxiety is rare or shameful, simply ask several friends if they’ve ever felt that way.
What is Reattribution?
Instead of blaming yourself entirely for a problem, you can think about the many factors that contributed to it. You can also focus on solving the problem instead of blaming yourself for it. Ask yourself, “What caused this problem? What did I contribute and what did others contribute? What can I learn from the situation?”
What is the Socratic Method?
Ask yourself several questions that will lead to the inconsistencies in your Negative Thoughts. For example, you might ask yourself, “When I say that I’m a ‘failure at life,’ do I mean that I fail at some things some of the time, or all things all of the time?”If you say, “some things some of the time,” you can point out that this is true of all human beings. If you say, “all things all of the time,” you can point out that this isn’t true of anyone, since no one fails at everything.
What is Thinking in Shades of Grey?
Instead of thinking about your problems in black-and-white categories, you evaluate them in shades of gray.
When things don’t work out as well as you’d hoped, you can think of the experience as a partial success or a learning opportunity. Pinpoint your specific errors instead of writing yourself off as a total failure.
What is Process vs. Outcome?
You evaluate your performance based on the process–the effort you put in–rather than the outcome. Your efforts are within your control, but the outcome is not.
What is the Semantic Method?
Substitute language that is less colorful and emotionally loaded. Instead of thinking, “I shouldn’t have made that mistake,” you can tell yourself, “It would be preferable if I hadn’t made that mistake.” This method is especially helpful for should statements and labeling.
What is “Let’s Define Terms?”
When you label yourself as “inferior” or “a fool” or “a loser,” ask yourself what those labels mean. You’ll see that there’s no such thing as a “fool” or a “loser.” Foolish behavior exists, but fools and losers do not. Ask yourself, “What’s the definition of ‘an inferior human being’ or ‘a loser’? What is my definition of someone who is hopeless? When I say I’m hopeless, what claim am I making?”
What is Be Specific?
Stick with reality and avoid judgments about reality. For example, instead of thinking of yourself as totally defective, you can focus on your specific strengths and weaknesses.
What is Self-Monitoring?
Keep track of repetitious Negative Thoughts or anxiety-producing fantasies by counting them. You can count your thoughts in a couple of different ways. You can keep a 3x5 card in your wallet or pocket. Each time you have a Negative Thought, put a tick mark on the card. Alternatively, you can use a wrist-counter like the ones golfers wear to keep track of their scores. At the end of the day, record the total on your calendar. Usually, the upsetting thoughts will diminish and disappear after about three weeks of Self-Monitoring.
What are the four steps of Agenda Setting?
a) The Invitation; b) Specificity; c) Conceptualization; and d) Methods
What are the Compassion-based Techniques?
There is only one: The Double Standard Technique
What is Dangling the Carrot?
This is the technique for overcoming resistance.
What is Sitting with Open Hands?
This is the technique for overcoming resistance.
What is the Magic Dial?
This is another useful tool to melt away Outcome Resistance. You can point out that in many cases, some negative feelings can be healthy and helpful. Here’s the kind of thing you can say to the patient: “If you had a Magic Dial and could adjust your feelings to the ideal levels, what would those levels be? Now you have a therapy goal that won’t threaten the patient. I also reassure patients that if we are too successful, and the anxiety drops below the ideal level (in this case 20%), I will help them generate some anxiety once again so they don’t get too complacent, or too happy. This often triggers some laughter and relief.
What is the Fallback Position?
This is a technique
for overcoming resistance.
What is the Acid Test?
Most patients will immediately agree to push the Magic Button. It sounds great to have all of your negative feelings suddenly vanish, just by pushing a button. However, the patient hasn’t yet grasped what we’re really offering. We’re offering to help patients feel happy and fulfilled in spite of their problems and shortcomings. We can’t change the facts of any patient’s life in today’s session. We can only help the patient develop greater happiness and self-esteem in spite of those facts. When you do the Acid Test, you make the patient suddenly aware of the implications of pressing the Magic Button.
What are the techniques (11) for dealing with Outcome Resistance?
- Dangling the Carrot
- Miracle Cure
- Magic Button
- Acid Test
- Positive Reframing
- Magic Dial
- Straightforward/Paradoxical Cost-Benefit Analysis
- Externalization of Resistance
- Devil’s Advocate Technique
- Sitting with Open Hands
- Fallback Position
What are some reasons someone may NOT want to push the Magic Button?
.This issues vary with regards to the conceptualization of the problem, but in general they involve: a) not deserving the outcome; b) changing
What is the Miracle Cure?
This is a technique for targeting Outcome Resistance. It is both a data gathering step as well as a useful Agenda Setting tool that may give you some important insights about why the patient is stuck. Once the patient has described the problem (such as procrastination, feelings of inadequacy, or a troubled relationship), you can ask what a “miracle cure” might look like. You might say something like this: “Suppose today was the most amazing session, and you walked out of the session thinking that our work together had changed your life in some fantastic, wonderful way. What would that change look like? What would be different? What would the solution to this problem look like?”
What are the basic PAS Techniques?
1) Empathy; 2) The Invitation; 3) Sitting with Open Hands; 4) Fallback Position; 5) Changing the Focus; 6) the Decision-Making Form
When does the TEAM Therapist issue the invitation, and what does he say at that time?
After a period of empathy and listening, one might say: “I would like to offer you something more than just support and listening, although that’s obviously of great importance. I’m wonder if there’s something you want help with in today’s session? You’ve mentioned a lot of heartbreaking issues today, such as . . I have many powerful tools to help you deal with these problems, and I’m wondering if this would be a good time for us to roll up our sleeves and get to work. Or, if you need more time to talk and vent, that’s okay too. I don’t want to jump in prematurely, before you’re ready.”
What are the typical sources of Outcome Resistance (Clinging to the Status Quo) with Anxiety?
a) Magical Thinking (My fears protect me or my loved ones. If I stop worrying, something terrible may happen); b) No Pain, No Gain (My constant worrying is the price I have to pay to do superb work. If I stop worrying, I’ll get complacent and fail; c) Conflict / Anger Phobia (I don’t want to face the problem that’s triggering my anxiety in the first place)
What are the Truth-Based Techniques?
They are: a) Examine the Evidence; b) Experimental Technique; c) Survey Method; and d) Reattribution
What are the Logic-Based Techniques?
They are: a) Socratic Method; b) Thinking in Shades of Gray; and c) Process vs. Outcome
What are the Semantic Techniques?
These are; 1) Semantic Method; 2) Let’s Define Terms; and 3) Be Specific
What is Paradoxical Inquiry?
Paradoxical inquiry can be helpful for Outcome and Process Resistance. When the patient resists, youcan ask a paradoxical question that may lead the patient to the irrationality of the resistance, rather than using persuasion in an attempt to change the patient’s mind. For example, the patient who’s describing a conflict with his brother may say, “Why should I have to change? He’s the one who’s screwed up.” Using PI you might say, “Certainly, you shouldn’t have to change and you don’t have to change. Are you saying that you don’t want to?” You can also point out that he may be saying that he doesn’t really want to work on the relationship, and perhaps just wanted you to know how difficult and irritating his brother is. If so, you can then ask if there’s something else he’d prefer to work on. PI must be delivered with warmth, respect, and authenticity.
How might a Gentle Ultimatum be presented with a depressed patient?
“Pedro, I’m looking forward to working with you to overcome the feelings of depression and worthlessness that have been plaguing you for so many years. However, if you want me to help you, you’re going have to do daily psychotherapy homework for 15 to 30 minutes, even when you’re not in the mood or feel convinced that it couldn’t possibly help. It’s a little like going to a tenniscoach to improve your tennis game. You’d have to practice between sessions to get the real benefit. And if you’re willing to do the homework, I believe I can show you how to change your life. That would be exciting to me.
What is a Brief Example of a Paradoxical Invitation?
“Are you asking for help with the problem with your husband, or did you simply want me to know about how lonely and frustrated you’ve been feeling?”
How might a Gentle Ultimatum be presented with a depressed patient?
Or, let’s say the patient is anxious, but doesn’t want to have to use exposure. You could point out that most therapists in the community offer long-term talk therapy without exposure for patients struggling with anxiety. You could also say, “If you feel strongly that you’re looking for that approach, I feel that you have every right to pursue it—but I don’t have those kinds of skills.” You can emphasize that you have great respect for the patient and hope she or he will decide to work with you. You can also let the patient know that you feel convinced that you can do some tremendous work together (Dangling the Carrot again.) However, they should know that the exposure requirement would not be negotiable.
What is a brief example of Sitting with Open Hands?
“It sounds like you don’t want any help with problems X. Y, and Z, and I’m fine with that. I’mwondering if there’s anything else that you do want help with that we could work on together?”
