Pocket Prep 4 Flashcards
Which of the following accurately conveys the idea of congruence as it relates to treatment?
The feeling by a client that the therapist is “real”
The feeling by a therapist that a client is “real”
The positive feeling a client has for a therapist
The positive feeling a therapist has for a client
Correct answer: The feeling by a client that the therapist is “real”
Carl Rogers, considered the founder of the humanistic school of therapy, highlighted the importance of congruence in treatment. In line with Rogers’ focus on the interpersonal, affective environment of the therapeutic dyad, congruence refers to the feeling by a client that a therapist is “real” and can support reliable and productive engagement.
Although positive mutual feelings are desirable, they are not what is meant by congruence.
Which of the following medications would be most likely used to address psychosis?
Abilify
Xanax
Paxil
Lithium
Correct answer: Abilify
Abilify (aripiprazole) is an antipsychotic often used to address psychosis and treat schizophrenia.
Paxil would more likely be used to treat panic. Lithium is a standard frontline medication for bipolar disorder. Xanax is often used to treat anxiety.
During a group session, one of the members admits that he sometimes feels relieved that his wife died from cancer several months ago, because they had a difficult marriage. The group member is tearful and obviously upset as he talks, and the counselor responds by validating the group member’s feelings in a genuine way. She praises him for opening up to the group and invites other group members to sensitively respond to the disclosure.
According to Yalom, this counselor is embodying which of the four leader functions?
Caring
Executive leadership functions
Meaning attribution
Emotional stimulation
Correct answer: Caring
Irvin Yalom, a well-known figure in the field of group counseling, believes that certain leadership functions are present in the field of group counseling. These leader functions include emotional stimulation, in which counselors encourage healthy expression of emotions; caring, which is characterized by warmth, acceptance, genuineness, and concern; meaning attribution, in which the group leader provides a cognitive perspective to group members’ experiences; and executive leadership, which is characterized by the group leader structuring the group and ensures that the group is moving in a particular direction
All of the following are typical goals of multicultural groups except:
increase group members’ understanding of norms acceptable by the majority culture
help group members understand how new skills can be integrated into the norms of their own cultures
understand the circumstances that brought group members into the group
provide learning for the individual in the group process
Correct answer: increase group members’ understanding of norms acceptable by the majority culture
Multicultural groups can present certain challenges for group counselors, particularly those not accustomed to working with those from different cultures. Counselors should always be aware of how their own understanding of other cultures impacts group members, and should take systemic and historical factors into account when interpreting group members’ responses. Typical goals of multicultural groups include understanding the circumstances that brought individuals into the group, providing learning for the group members, and helping group members understand how newly learned skills can fit within their own cultural constructs. Increasing group members’ understanding of acceptable norms in the majority culture would not be a goal of group counseling.
Sociometry, the study of interpersonal relationships within a group, was first developed by what psychotherapist?
Irvin Yalom
Jacob Moreno
Alfred Adler
R. K. Coyne
Correct answer: Jacob Moreno
Jacob Moreno (1889–1974) was a psychotherapist and social scientist known for his contributions of sociometry and psychodrama to group psychotherapy. Sociometry, the study and measurement of social relationships, has been developed even more since Moreno’s death to be culturally and ethnically inclusive.
Which of the following would be an accurate overall statement about transference?
Transference is extra feelings brought into the therapeutic relationship by the patient
Transference is any extra feelings brought into the therapeutic relationship by anyone
Transference is extra feelings brought into the therapeutic relationship by the therapist
Transference is an outdated notion that research has disproven
Correct answer: Transference is extra feelings brought into the therapeutic relationship by the patient
Transference was first identified and described by Sigmund Freud. Essentially, it is the extra feelings brought into the therapeutic relationship by the patient from another relationship in their life. These could be romantic, hostile, parental, or something else.
The extra feelings brought into the therapeutic relationship by the therapist would be known as countertransference. Rather than being an outdated notion, the idea of transference and countertransference is something therapists deal with often in practice.
Which of the following is the function of a negative-feedback loop in family therapy?
To preserve homeostasis and effect change To violate homeostasis and effect change
To violate homeostasis and prevent change
To preserve homeostasis and prevent change
Correct answer: To preserve homeostasis and prevent change
In family therapy, feedback loops are the result of interlocking family systems, which are dedicated to preventing change and preserving homeostasis, even if this homeostasis enables dysfunction. A negative-feedback loop acts to preserve homeostasis and prevent change.
One cannot both preserve homeostasis and effect change, and a negative-feedback loop does not violate homeostasis.
Which of the following medications would most likely be used to treat panic disorder?
Ritalin
Zoloft
Geodon
Ativan
Correct answer: Ativan
Ativan (lorazepam) is often used to treat panic disorder and anxiety.
Geodon is an antipsychotic used to treat psychosis and schizophrenia. Ritalin is the main treatment for ADHD. Zoloft is an antidepressant used to treat clinical depression.
Which of the following are considered the most effective psychotherapeutic interventions for depressive disorders?
Cognitive behavior therapy and Gestalt therapy
Cognitive behavior therapy and family therapy
Cognitive behavior therapy and interpersonal therapy
Cognitive behavior therapy and Reality therapy
Correct answer: Cognitive behavior therapy and interpersonal therapy
Depressive disorders can be treated in a variety of ways. Among these, those which have been found to be most effective are Cognitive behavior therapy and interpersonal therapy.
Reality therapy and Gestalt therapy may or may not be used to treat depressive disorders. They are not considered as effective in this regard as cognitive behavior therapy and interpersonal therapy. Family therapy is rarely used to treat individual depressive disorders per se.
Which of the following would be the best example of enactment?
A therapist adopting the style of the family
A therapist showing the family how they see them interact
A mother and daughter stating their feelings for each other
A father and son showing how they interact at home
Correct answer: A father and son showing how they interact at home
In structural family therapy, enactment refers to a role-playing strategy in which members of the family play themselves in their various roles and interactions so that the therapist can observe and address what is seen. A father and son showing how they interact at home would be one example.
Enactment is not a simple restatement of feelings, nor is it the therapist adopting the family’s style (mimesis) or mimicking their interactions.
Albert Bandura is credited with the development of social learning theory, which stresses the importance of both social and cognitive factors for individuals. What is one of the central concepts of social learning theory?
Diversity
Self-efficacy
Relativism
Defense mechanisms
Correct answer: Self-efficacy
One of the central concepts of Albert Bandura’s social learning theory is self-efficacy, which is an individual’s belief that he or she is able to perform a certain behavior. Self-efficacy can be encouraged through modeling, observing others, receiving verbal persuasion from others, and staying in tune with one’s physiological states.
A family counselor who consciously joins with the family during sessions, observes what he experiences during those sessions, and then makes interpretations to family members is most likely operating from what perspective?
Experiential
Bowen
Humanistic
Narrative
Explanation
Correct answer: Experiential
Experiential family therapy was developed by Carl Whitaker, who takes a very active role in the therapeutic process. Experiential family counselors attempt to join the family during therapy sessions, using their own personal experiences as family members to initiate change within the family system. In experiential family therapy, symbolism is a tool counselors use to explain family members’ experiences.
A group counselor often uses the empty chair technique and guides group members to fantasize about how they might create change in their lives. This counselor is operating from what counseling approach?
Rational emotive behavior
Reality
Transactional analysis
Gestalt
Correct answer: Gestalt
The Gestalt counseling approach focuses on the here and now rather than past experiences, and uses experiential techniques that encourage group members to take responsibility for their moment-to-moment experiences. Techniques used in Gestalt counseling include the empty chair and guided fantasy techniques, both of which help integrate affect into the present moment and help group members work through unfinished business.
If a family is considering conjoint therapy, which of the following is likely?
A session where the whole family is present
A session where the therapist leaves the room at times
A session with reenactment of family dynamics
A session where only individual members are present
Correct answer: A session where the whole family is present
In terms of family therapy, conjoint means that there is more than one family member present during the session. Thus, a session where the whole family is present would be a good example.
The concept does not refer to individual sessions and might or might not involve techniques such as reenactment or leaving the room.
Edward has many areas of frustration in his life, many of them arising from a sense of powerlessness. He is not treated well at work by his boss, and his friends never give him a say in what they do socially.
If Edward engages in displacement, which of the following reactions is most likely?
Attempt to dominate his household
Believe that he is really in charge
Become hostile to his friends and his boss
Avoid his friends and minimize work interactions with his boss
Correct answer: Attempt to dominate his household
Defense mechanisms are means by which the psyche protects itself from unwanted thoughts, drives, or emotions. Edward is uncomfortable feeling powerless; if he engages in displacement, he will move that conflicted feeling to another part of his life. In this case, he will exert his desire for dominance that is thwarted elsewhere.
Avoidance and hostility would not necessarily be defense mechanisms. If Edward tries to believe that he is in charge, this might signal denia
Which of the following would be a proxemic intervention?
Attending to facial expressions
Altering seating arrangements
Correcting individual posture
Monitoring personal space
Correct answer: Altering seating arrangements
Proxemics refers to the science of spatial features of the environment, such as furniture placement and seating arrangements. The arrangement of objects in physical space has a measurable effect on behavior and can be used as a form of psychological intervention.
Monitoring personal space, correcting individual posture, and attending to facial expressions would be more exemplary of kinesics, which is the study of nonlinguistic communication.
Which of the following is the element some researchers see in vicarious trauma as opposed to secondary traumatic stress?
\
Vicarious trauma is more severe than secondary traumatic stress
Vicarious trauma is less severe than secondary traumatic stress
Vicarious trauma involves a change in a person’s beliefs and sense of self
Vicarious trauma involves mirroring the symptoms of the client
Correct answer: Vicarious trauma involves a change in a person’s beliefs and sense of self
Though some have used the terms interchangeably, vicarious trauma, in the opinion of many researchers, is not the same as secondary traumatic stress. In the opinion of these researchers, the meaning of vicarious trauma is more specific and involves changes on the part of the professional, including a change in beliefs and sense of self.
Vicarious trauma and compassion fatigue are not linked by a definite relationship of more or less severe, and vicarious trauma may or may not involve mirroring client symptoms.
All of the following are stages of a group as defined by Irvin Yalom, except which one?
Orientation
Termination
Cohesion
Storming
Correct answer: Storming
Irvin Yalom is known for his contributions to group counseling theory. He identified four stages: orientation, conflict, cohesion, and termination. “Storming” is the second group stage in a theory identified by Tuckman, not Yalom.
What would be characteristic of a horizontal therapeutic relationship?
A therapist having an elevated status with respect to the client
A client and therapist meeting as equals in status
A client and therapist having a dual relationship
A client and therapist sharing personal details
Correct answer: A client and therapist meeting as equals in status
Martin Buber described the idea of an “I-thou” relationship that promoted equity and mutual respect. In counseling, this is often described as a horizontal relationship, in which the attitude of expertise is deemphasized in favor of a more equitable therapeutic interaction.
Clients and therapists sharing personal details or having dual relationships would not be horizontal. Similarly, the therapist having an elevated status with respect to the client would not constitute a horizontal relationship.
Which of the following would best characterize good participatory group leadership?
Establishing and enforcing boundaries
Allowing the group to take its own course
Delegating leadership as soon as possible
Modeling what the leader wants to see
Correct answer: Modeling what the leader wants to see
In most cases, the best way for a participatory group leader to approach their role is to model what they want to see. Although the group leader should allow the group to do the group’s work, modeling participation will enhance the opportunity for everyone to be heard.
Delegating leadership is likely not necessary in a participatory group. Although boundaries are important, the group will look to a designated leader for cues on how to behave more than a set of rules.
All of the following are principles underlying existential theory except which one?
With freedom of choice comes personal responsibility
Clients have the freedom to choose what they do and how they react
Self-talk is the source of emotional disturbance
Individuals are motivated to find meaning in their life journeys
Correct answer: Self-talk is the source of emotional disturbance
Existential therapy focuses on the direct experiences of clients’ lives, and the goal of this type of therapy is for clients to understand one’s being and who one is and is becoming. Existential therapists believe that clients have the freedom to choose and are responsible for their own fate.
Rational Emotive Behavior Therapy (REBT) is a different type of therapy that asserts that self-talk is the source of emotional disturbance.
Which of the following would be the first step in systematic desensitization?
Imaginative desensitization
In vivo desensitization
Construction of anxiety hierarchy
Relaxation training
Correct answer: Relaxation training
Systematic desensitization deals with a person’s systematically reduced anxiety when exposed to a certain stimulus. It is generally seen as proceeding through four stages.
Relaxation training to gain control of one’s responses
Construction of anxiety hierarchy to gain intellectual knowledge of one’s fear
Imaginative desensitization to explore one’s fear in safe circumstances
In vivo sensitization to gain control over the feared stimulus
The progression is necessarily stepwise and iterative.
Which of the following would be a good example of the risky shift phenomenon in groups?
A group of auto mechanics decides on the least expensive option for a customer
A group of clinicians has widely different opinions about a case
An individual makes a decision that makes them ineligible for group membership
A committee of conservative financial planners decides on a generous subsidy
Correct answer: A committee of conservative financial planners decides on a generous subsidy
The risky shift phenomenon as known in groups is significant in the study of how groups operate in both their therapeutic and non-therapeutic character. The phenomenon refers to the fact that a group can take on a personality of sorts that is distinct from that of any individual member, and that this personality can arrive at a decision that is more radical than any individual member would make on their own. Thus, a committee of bankers who are otherwise fiscally conservative might select the more risky step of deciding on a generous subsidy.
The other examples do not illustrate this phenomenon of a group making a more risky decision that is out of character with individual personalities.
Which of the following would be a good example of a tertiary prevention group?
A group helping first responders understand trauma
A group helping first responders with severe PTSD
A group helping first responders deal with traumatic experiences
A group helping first responders share stories of difficult situations
Correct answer: A group helping first responders with severe PTSD
Groups are sometimes organized around a particular health issue for a population in hopes of either forestalling harm from that issue altogether or dealing with a degree of harm that already exists. These are called prevention groups. A tertiary prevention group deals with a condition that already exists and is likely severe in an individual, after total prevention and partial mitigation have failed. An example would be a group helping first responders deal with their severe PTSD.
The other groups educate about trauma before it happens or deal with trauma that has not yet resulted in severe health consequences.
Which of the following would be true of a cued panic attack?
It is a controlled panic attack under supervision
It sets up further panic attacks
It takes place at a random time
It takes place as a result of a specific trigger
Correct answer: It takes place as a result of a specific trigger
Panic attacks are sudden-onset periods of intense anxiety. The sufferer often feels as though they are having a heart attack. A cued panic attack is one in which there is a specific environmental trigger for onset, such as being in a high place or seeing a thunderstorm.
An uncued panic attack would be one without such a trigger or taking place at a random time. Panic attacks are not usually enacted under supervision, and the term does not refer to a set of panic attacks.
In a group for individuals who have recently lost a family member to cancer, the counselor notices that one member, an Asian woman, rarely speaks. When she is asked a question directly, she quickly answers but does not elaborate. Which of the following is the most likely reason for her behavior?
The woman does not understand what is being said by others in the group.
The woman is following cultural norms that discourage sharing personal information with others
The woman is resisting talking about her late husband because it is too painful
The woman does not think that the group is helpful to her
Correct answer: The woman is following cultural norms that discourage sharing personal information with others
There may be special issues present in counseling groups with multicultural clients. For example, some cultures discourage sharing personal information with others and individuals may not want to defy family customs. In this situation, while the woman’s silence might be resistance, it might also be a result of her cultural beliefs and norms. The group counselor should respect this possibility and explore reasons other than resistance for her behaviors.
Which of the following is an accurate statement regarding Alfred Adler’s view of neurosis?
Neurosis is a failure in learning
Neurosis is an artifact of the unconscious self
Neurosis is a chosen response to pressure
Neurosis is a brain disease
Correct answer: Neurosis is a failure in learning
Alfred Adler defined the complicated notion of neurosis as a failure in learning that leads to distorted perceptions about the world. Though now less common as a descriptor of client characteristics, neurosis can be said (in psychoanalytic terms) to be the failure of the ego to deal with the conflicting pressures of id and superego, with various manifestations in client affect and behavior.
According to Adler, neurosis is not a brain disease, chosen, or an artifact of the unconscious.
A counselor explains to group members the expectations for them and plays an active role in helping group members to share their thoughts and feelings with each other. The leader guides group members in creating shared goals and structures for the group as well. What stage of group development is this group currently experiencing, according to Corey?
Stage 1
Stage 2
Stage 3
Stage 4
Correct answer: Stage 2
Stage 2 of the group process, as established by Corey, is when group members are oriented to the group process. During this stage, the group counselor typically states expectations and ground rules for the group and helps members share thoughts and feelings with each other. The counselor is particularly important during this part of the group process, as she or he models appropriate interpersonal skills and how to be genuine and spontaneous.
Stage 1 is formation, when the group counselor screens and selects group members. Stage 3 is transition, which deals with handling resistance and conflict. Stage 4 is working, when the group becomes more productive and less dependent on the leader.
Which of the following accurately states the perspective of reality therapy toward psychiatric pharmacology?
Medication is a good frontline treatment for psychopathology
Medication should be tried after psychotherapy, not before or during
Medication is not the answer to psychopathology
Medication is useful but likely not necessary in treatment
Correct answer: Medication is not the answer to psychopathology
Glasser’s reality therapy remains controversial in various ways, one of which is its stance toward psychiatric pharmacology. In short, reality therapy contends that medication is not the answer to psychopathology and that psychological distress is largely the responsibility of the person in therapy.
The other statements are not consistent with the perspective of reality therapy toward psychiatric pharmacology.
According to strategic family counseling, what is double-bind communication?
When communication is forbidden in a family
When behavior and an overt message are incongruent
When communication styles differ between parents
When behavior and an overt message are congruent
Correct answer: When behavior and an overt message are incongruent
In the language of strategic family counseling, double-bind communication is when a person’s behavior is incongruent with their overt message; for example, when a parent says they love a child but does not act loving in practice.
The term does not have to do with barriers to communication or different parental communication styles.
A counselor is meeting with a client who struggles with chronic substance abuse and depression. The client regularly shares that he feels left out and expresses his belief that life is unfair. According to Adlerian theory, this client is most likely to be a(n):
middle child
twin
oldest child
second child
Correct answer: middle child
Alfred Adler’s work focused significantly on birth order and family constellation. According to Adler, birth order affects individuals’ psychological environments and affects the child’s unique experience. The eldest child tends to get a lot of attention, is hard-working and dependable, and fears losing love when a sibling comes along. Middle children see themselves in competition with the older sibling(s), may view life as unfair, and often feel left out. The youngest child often tends to go his or her own way and is influenced by all other siblings. Individuals who are only children have difficulty cooperating, often handle adult interactions well, and want to be the center of attention.
Which of the following would be the best candidate for the technique of thought-stopping?
A man with anxiety about driving
A man with delusional thoughts about the government
A man troubled by obsessive thoughts about the past
A man worried that he is drinking too much
Correct answer: A man troubled by obsessive thoughts about the past
The technique of thought-stopping refers to the practice of taking aggressive action against unwanted thoughts that are obsessive or intrusive. One example of a good candidate for this approach would be a man troubled by obsessive thoughts about the past. The man might be offered the technique of saying “stop” whenever such thoughts begin to intrude.
The technique is not a first-line treatment for substance abuse or anxiety, although it may help with automatic thoughts related to larger issues. Delusion is likely not going to be helped by thought-stopping, as the false beliefs will remain.
Who is ultimately in charge of what constitutes privileged communication?
It is a matter of civic jurisdiction
It is a matter of federal law
It is a matter of state law
It is a matter of professional code
Correct answer: It is a matter of state law
Although there are multiple layers of confidentiality, and all must be considered in practice, this is usually considered to be a matter of state law. Federal laws (such as HIPAA) are also applicable, as well as professional or local standards.
It is part of a professional’s competence to know all of the prevailing codes concerning privileged communication and be able to explain these to patients.
Which of the following is the point of chain analysis?
To identify the antecedents of behavior
To identify the results of behavior
To identify the impact of behavior
To identify the meaning of behavior
Correct answer: To identify the antecedents of behavior
In Linehan’s dialectical behavior therapy (DBT), chain analysis refers to the process of identifying the antecedents of behavior in order to understand one’s own behavior as a process that can be analyzed, understood, and altered.
Chain analysis in this context does not refer to identifying the results of behavior, the impact of behavior, or the meaning of behavior.
Which of the following would be the first stage in a systematic desensitization strategy for a person who is afraid of dogs?
Being introduced to a friendly therapy dog
Seeing a picture of an angry dog
Having a discussion about their fear of dogs
Visiting a busy dog kennel
Correct answer: Having a discussion about their fear of dogs
Systematic desensitization is a strategy usually designed to reduce one’s fear of something. The goal is to proceed from the least vivid interaction with the stimulus to the most vivid interaction. In this case, the person having a discussion about their fear of dogs is not just the likely first step of the assessment; it will also be somewhat stressful in its own right and is therefore a good first step.
Visiting a busy dog kennel, encountering a live therapy dog, and seeing a picture of an angry dog would all be significantly more stressful and belong to the later stages of a systematic desensitization process.
In what group situation does a laissez-faire style of leadership work best?
In groups that have not yet become cohesive
In groups that require quick decision-making
In groups where members are committed to a common goal
In groups made up of people from many different backgrounds
Correct answer: In groups where members are committed to a common goal
Group counselors should explore several types of leadership styles and decide which style works best for them in certain group situations. The laissez-faire style of leadership works best in groups that share a common goal and are self-motivated. The democratic style of leadership is well-liked, but not as efficient as the autocratic style of leadership. This style leads to quick decision-making but may not always take every group member’s opinion into consideration.
In what situation might a group counselor want to avoid assembling a heterogeneous group?
When the counselor wants to stimulate interaction
When it is the first time groups members have been in counseling
When group members have low cognitive functioning
When the counselor is especially
concerned with group members’ ability to relate to each other
Correct answer: When the counselor is especially concerned with group members’ ability to relate to each other
Counselors may want to form heterogeneous groups since they more accurately reflect real-world experiences and expose group members to a variety of opinions and backgrounds. However, if counselors are concerned about group members being able to relate to each other and their problems, they should try to create homogeneity within the group so that the group is made up of similar kinds of members.
In practice, would an open-ended question or a closed-ended question elicit more information?
A closed-ended question
Both elicit similar information
An open-ended question
Neither in this respect
Correct answer: An open-ended question
The practice of counseling rests on the ability of the client and the therapist to communicate effectively, as well as for the therapist to be able to gather as much information as possible about a client’s circumstances.
Closed-ended questions (e.g., yes/no) have their uses but do not gain as much information as open-ended questions, such as “How do you feel about your relationship with your wife?’ Open-ended questions put the client in control in terms of how much and what information to divulge.
Which of the following schools of therapy involves the therapist acting as the client’s friend?
Psychoanalysis
Transactional analysis
Dialectical behavioral therapy
Reality therapy
Correct answer: Reality therapy
William Glasser’s reality therapy is different from other treatment modalities and schools of therapy in various ways. One of them is the overall approach to the client. In reality therapy, the idea seems to be to act as the client’s friend, with as little pretense as possible to traditional therapeutic roles.
Dialectical behavioral therapy (DBT), transactional analysis (TA), and psychoanalysis rely on more standard roles in the therapeutic dyad.
In which of the following cases is a laissez-faire group leadership style most likely to be effective?
When the group is in need of psychoeducation
When the group is being taught a skill
When the group is strongly aligned toward a common goal
When the group is exploring a sensitive traumatic issue
Correct answer: When the group is strongly aligned toward a common goal
Although all groups take on an identity of their own, the leadership style of the designated group leader has a major impact on function and results. A laissez-faire style of leadership is very “hands-off” and allows the group to function largely without direction. This would be most appropriate in cases where the group is strongly aligned toward a common goal, as the group members will each be motivated to cooperate without direction.
Psychoeducation, the exploration of sensitive traumatic issues, and teaching a skill all call for the group leader to take on a more active and directive role.
Which of the following is true about trauma and disaster counseling?
Its effectiveness cannot be measured using standard instruments
Its effectiveness is more a matter of conjecture than data
Beginners are often as effective as experts
Unique skills and training are required
Correct answer: Unique skills and training are required
Trauma and disaster counseling is a highly specialized and rapidly growing field. It has been proven effective as per a variety of standard and non-standard instruments, which suggest that trauma and disaster counseling are the preferred mode of treatment for certain cases. However, unique skills and training are required, and it is not a field in which beginners are as effective as experts.
Which level of consciousness includes everything the mind is not currently aware of but can call upon if needed?
Conscious
Unconscious
Protoconscious
Preconscious
Correct answer: Preconscious
The mind is sometimes conceptualized as having three levels, defined by what kind of information is contained and how accessible it is. The preconscious mind contains everything the mind is not currently aware of but can call upon if needed, such as a cookie recipe or a conversation one had yesterday.
The conscious mind contains all the information of which the mind is currently aware. The unconscious mind contains everything the mind has that is neither part of current awareness nor consciously accessible. Protoconscious is a fabricated term.
Diane has been suffering from a phobia of cats for most of her life. She is engaging in systematic desensitization to reduce this anxiety. She has learned to control her physical responses to the idea of cats and feels that she can do so going forward.
Which of the following will happen next?
Going through an exercise of visualizing
cats
Learning deep-breathing exercises to deal with the fear of cats
Being directly exposed to a cat
Figuring out what level of exposure to cats is most distressing
Correct answer: Figuring out what level of exposure to cats is most distressing
Systematic desensitization deals with a person’s systematically reduced anxiety when exposed to a certain stimulus. It is generally seen as proceeding through four stages.
Relaxation training to gain control of one’s responses
Construction of anxiety hierarchy to gain intellectual knowledge of one’s fear
Imaginative desensitization to explore one’s fear in safe circumstances
In vivo sensitization to gain control over the feared stimulus
The progression is necessarily stepwise and iterative. In this case, as the physical responses to cats have already been mastered, the next step is to arrange an intellectual hierarchy of distress with respect to cats. Then would come the exercise of visualization, followed by direct exposure. Deep breathing and other response exercises have already been done.
In reality therapy, what would be the least likely focus of a session?
The client’s conflicts with family
The client’s unhappiness about their job
The client’s feelings about their significant other
The client’s failed relationships in the past
Correct answer: The client’s failed relationships in the past
William Glasser’s reality therapy focuses almost exclusively on the here and now, including the improvement of present circumstances like relationships and opportunities for growth. Personal responsibility is stressed as a driver of client wellness.
Reality therapy focuses far less on the past in any sense, including past relationships.
Why does experiential therapy use confrontation with clients?
To help clients stay with their feelings
To address negative personality traits
To call attention to falsehood
To heighten personal awareness
Correct answer: To help clients stay with their feelings
Experiential therapy attempts to keep the client “in the moment” with their feelings in order to relive a past experience vividly in the therapeutic environment. Confrontation may be used to help clients stay with their feelings and not drift into intellectualization or over-cognition.
Confrontation in experiential therapy would not be used to call attention to falsehood per se, nor would it be to heighten personal awareness or address negative persona
Which of the following questions would likely be practiced by a group leader using a linking technique?
“How do you think your personal narrative has changed since the last time you brought this up?”
“Is there anyone in your life who you can depend on for support in any circumstance?”
“Did you notice you described your accident the same way your colleague did?”
“Who do you think you can reach out to if you need help after the group?”
orrect answer: “Did you notice you described your accident the same way your colleague did?”
In the context of group work, linking refers to the practice of referring similar conditions or experiences within the group to each other. In other words, linking occurs when one group member finds their issue directly resonating with that of another. Directly eliciting this connection is the technique of linking.
The other statements do not consist of a group member linking their experience with another directly.
Which of the following would not be a focus of assertiveness training?
Ability to express one’s rights without violating those of others
Ability to express all emotions
Ability to know the difference
between aggression and assertion
Ability to describe trauma related to passivity
Correct answer: Ability to describe trauma related to passivity
Assertiveness training seeks to help an individual express all their emotions, express their own rights without violating those of others, and know the difference between assertion and aggression. It does not focus as much on the past, including assessments of how trauma may or may not have contributed to a more passive character; rather, it is a skill-building technique related to expression in present reality
Reinforcement theory and cognitive information processing are important concepts in whose theory of career counseling?
Axelrad
Gottfredson
Holland
Krumboltz
Correct answer: Krumboltz
John Krumboltz developed the Learning Theory of Career Counseling (LTCC), based on Bandura’s social learning theory. Important concepts in Krumboltz’s theory include reinforcement theory, cognitive information processing, and classical behaviorism as ways of modifying and molding career development and decision making.
Which animals are most commonly used in animal-assisted therapy?
Dogs and horses
Cows and sheep
Mice and hamsters
Chickens and ducks
Correct answer: Dogs and horses
Animal-assisted therapy has been recognized as contributing to better relationship building, as relationship building with an animal mirrors in many ways the trust and relationship building done with humans. The most commonly used animals in animal-assisted therapy are dogs and horses, with specialties available in these disciplines, but many other kinds of animals could be used.
The other animals listed are not as commonly used as dogs and horses.
Frederick has just lost his grandfather, with whom he was very close. If Frederick engages in introjection, which of the following is a likely behavior?
He will insist that his grandfather is still around in some way
He will become hostile at the mention of his grandfather
He will take on aspects of his grandfather’s personality
He will forget about his grandfather
Correct answer: He will take on aspects of his grandfather’s personality
Defense mechanisms are ways in which the psyche protects itself from unwanted disruptions to its equilibrium. If Frederick engages in introjection, he is most likely to take on aspects of his grandfather’s personality in an attempt to ward off grief.
Forgetting about his grandfather might signal repression. Becoming hostile at the mention of his grandfather would not necessarily be a defense mechanism. Insisting that his grandfather is still around in some way would be classic denial.
Which of the following would be a good example of a secondary prevention group?
A group educating people about the risk of methamphetamine
A group educating people about treatment options for their methamphetamine problem
A group helping people with early methamphetamine problems
A group helping people with profound health issues related to methamphetamine
Correct answer: A group helping people with early methamphetamine problems
Groups are sometimes formed around a particular well-known issue for those suffering from that particular problem. In prevention groups, the focus is on avoiding harm altogether or mitigating harm from a disease process that already exists. A secondary prevention group seeks to deal with an early stage problem where significant harm can still be avoided, as in the case of a group helping people with early methamphetamine problems.
The other groups either deal with a problem that is not yet manifest or already severe.
Which of the following is considered the last in Prochaska’s five-stage model of change?
Maintenance
Contemplation
Precontemplation
Action
Correct answer: Maintenance
Prochaska’s five-stage model of change is widely used in treatment contexts. It consists of five stages:
Precontemplation, in which a person likely does not see the need to change
Contemplation, in which a person is ambivalent about change
Preparation, in which a person gathers resources and information to change
Action, in which the first steps of change are enacted
Maintenance, in which desired behaviors are repeated
Which of the following would be the most accurate statement about group treatment?
They are supported by research but are not more effective than single-patient modalities
They are not supported by research and are not as effective as single patient modalities
They are supported by research and are more effective than single-patient modalities
They are not supported by research but can be more effective than single-patient modalities
Correct answer: They are supported by research but are not more effective than single-patient modalities
Hundreds of studies attest to the efficacy of group work; the modality of group therapy in its various forms is well-supported by research. However, it is not accurate to say that group treatment is more effective than single-patient modalities. Shy clients or those preoccupied with interpersonal dynamics may not benefit from group work, but group work can provide advantages that single-patient modalities cannot, such as affiliation, social accountability, and non-expert engagement.
What type of family counseling is most likely to include introjects and the concept of psychological heritage?
Behavioral
Reality
Psychoanalytic
Gestalt
Correct answer: Psychoanalytic
Psychoanalytic family counseling, developed by Nathan Ackerman, builds on concepts from classical psychoanalysis. Key concepts include addressing introjects (imprints or memories) from other relationships of significance, as well as psychological heritage (the psychodynamic history of one’s family of origin).
Gestalt family counseling, behavioral counseling that takes place within the context of family counseling, and reality family therapy do not address these concepts explicitly.
Which of the following is most characteristic of Thorne’s psychotherapy integration?
To use more than one theoretical school of psychotherapy
To attempt the unification of the various parts of the psyche
To form one’s own school of psychotherapy from different parts
To use techniques from various schools of psychotherapy
Correct answer: To use more than one theoretical school of psychotherapy
FrederickThorne’s psychotherapy integration, as opposed to eclecticism, does not simply take techniques of various schools of psychotherapy; rather, it fully integrates more than one theoretical school of psychotherapy.
Psychotherapy integration does not refer to forming one’s own theoretical school, nor does it directly address psychological unification.
A counselor is conducting diagnostic sessions with a family and wants to learn more about the family’s dynamics, unspoken rules, and communication patterns. Which of the following would be the best tool for the counselor to use?
Open system
Ecomap
Genogram
Strategic approach
Correct answer: Genogram
A genogram is a tool counselors can use to assess family dynamics. Genograms, used particularly by Bowen and his followers, are representations of a family tree that are used to explore relationships between family members. Families can complete a genogram together either during or between sessions.
What is the difference between open and closed groups?
Open groups allow members to contribute topics, while closed groups do not
Open groups allow members to join after the initial selection, while closed groups do not
Open groups are not clinical in nature, while closed groups are
Open groups allow for rotating group
leadership, while closed groups do not
Correct answer: Open groups allow members to join after the initial selection, while closed groups do not
The main difference between open and closed groups is that open groups allow members to join after the initial selection, while closed groups do not.
The distinction is not based on whether group members can contribute topics, leadership changes, or clinical focus.
A patient comes in with feelings of intense fear about life in general and concern that they may not find a mate. If the therapist were to engage in the paradoxical intervention of positioning, which of the following would be the most likely response?
“What would the world be like if you didn’t fear being alone?”
“You definitely won’t find a mate and will spend every minute alone for the rest of your life.”
“Can you paint a picture of your ideal mate for me?”
“You should evaluate your previous successes and see what they tell you.”
Correct answer: “You definitely won’t find a mate and will spend every minute alone for the rest of your life.”
Paradoxical interventions in therapy are used to violate the expectations of the client in a therapeutic manner. Perhaps by doing so, various therapeutic benefits are realized. One of these would be an internal challenge to the catastrophizing of the client; in this case, by exaggerating the client’s fear to a point where the client can take a new perspective and begin to deal with reality rather than emotional reality construction. This is called positioning.
The other statements are not paradoxical but are more traditional therapeutic questions.
Howard is beginning a group designed to help its members become more assertive in business contexts. Training exercises and modeling activities are enacted. Which of the following types does this group resemble?
T-group
Psychoeducation group
Counseling group
Group therapy
Correct answer: T-group
A T-group (training group) is designed to help its members acquire specific skills and is often enacted in business or professional contexts.
A counseling group is designed to address issues of personal growth and development, while group therapy is a deeper and more clinical modality that addresses pathology. A psychoeducation group teaches its members about a specific issue they are facing.
Why might meaning attribution be an important function of group leaders?
It can help group members feel validated and accepted
It may create an environment in which group members feel more comfortable expressing deep emotions and personal values and beliefs
It helps group members have a common understanding of what is being expressed, and can increase familiarity with emotions and feelings
It provides a structure and framework for each group session, implementing predictability and consistency
Correct answer: It helps group members have a common understanding of what is being expressed, and can increase familiarity with emotions and feelings
Irvin Yalom originally suggested that certain leadership functions—emotional stimulation, caring, meaning attribution, and executive leadership—are present in group counseling, no matter the style or theoretical orientation of the leader. Meaning attribution refers to the cognitive understanding that is made of the events in the group, which can enhance collective experiences and increase familiarity with emotions and feelings.
Which of the following would be the best example of a differentiated person in Bowen’s intergenerational family therapy?
A person who does not consider themselves part of their family
A person who does not react automatically to the emotions of others
A person who has found an identity outside the family
A person who has firm boundaries between themselves and their family
Correct answer: A person who does not react automatically to the emotions of others
According to Bowen’s intergenerational family therapy, a person can be considered differentiated when they are in control of the engagement of their intellectual self as opposed to their emotional self. One example might be a person who does not react automatically to the emotions of others.
Differentiation in this context does not refer to family boundaries or individual identity.
Can psychotherapy restructure neural networks in the brain?
No, unless medication is involved
No, under no circumstances
Yes, in many circumstances
Yes, in those suffering from trauma
Correct answer: Yes, in many circumstances
The concept of neuroplasticity essentially means that the brain is not static and can adapt and positively change in response to circumstances. By training new skills and engaging in new relational and behavioral patterns, the brain’s neural network can be restructured by psychotherapy.
This is true for those suffering from trauma in addition to other presentations.
According to Murray Bowen, what is the basic building block of the family emotional system?
The mother and father
The individual
Childhood experiences
The triangle
Correct answer: The triangle
Murray Bowen is well-known for his comprehensive contributions to the field of systems family counseling. Bowen’s approach is transgenerational, meaning that he believes communication patterns and dynamics are passed down from one generation to the next. He believes that triangles within family systems represent the most basic building blocks of a family’s emotional system. In a triangle, emotional discomfort that exists between two family members may be somewhat alleviated by bringing in a third family member to resolve the stress. Bowen also stresses the importance of self-differentiation, projection onto children in families, birth order and sibling position, and societal regression.
To create a hierarchy of fear when engaging in systematic desensitization, which of the following is the optimal number of items?
10-20
1-5
5-10
10-15
Correct answer: 10-15
The technique of systematic desensitization relies on a stepwise, iterative process of controlling nervous system responses, creating a hierarchy of fear with respect to the feared stimulus, imaginative exercises with respect to the feared stimulus, and finally in vivo exposure to a feared stimulus.
According to behaviorists, one should construct a list of 10-15 items to create an effective hierarchy of fear with respect to the feared stimulus, which is graded from low to high at approximately equal intervals
A counselor at an elementary school would like to start a social skills group for kindergartners, who are typically five and six years old. What is the maximum number of group members the counselor should have in each group?
Eight
Four
Six
Two
Correct answer: Four
When forming groups of young children, counselors should be careful to consider the participants’ developmental ages, abilities, and attention spans. Typically, no more than four children should be included in a group for children who are five or six years old. Older children may be able to tolerate a larger group setting.
If a person is undergoing aversive treatment, what does this mean?
The person is experiencing immersive inpatient treatment
The person is experiencing occasional outpatient treatment
The person is experiencing punishment as an aspect of treatment
The person is experiencing rewards as an aspect of treatment
Correct answer: The person is experiencing punishment as an aspect of treatment
Aversive treatment is aimed at reducing a behavior, generally by adding a punishment. An example would be the treatment of alcoholism with Antabuse, which produces great discomfort when alcohol is ingested.
Aversive treatment does not involve the frequency or setting of treatment, and it would not involve rewards.
Carl Jung is known for his belief in the collective unconscious. His theory serves as a way of understanding humans’ emotional responses to issues of self and purpose. Which of the following is based on Jung’s theory?
Beck Depression Inventory
Rorschach Inkblot Test
Myers-Briggs Type Indicator
WISC-IV
Correct answer: Myers-Briggs Type Indicator
Carl Jung was a strong proponent of the collective unconscious, which has developed in the human species over time and contains archetypes for humans’ intense emotional responses. Goals of Jungian therapy include getting to know oneself, integration of self, and transformation of self. Jung introduced the concepts of introversion and extraversion, both of which are measured on the Myers-Briggs Type Indicator.
What is the difference between wilderness therapy and adventure-based counseling?
Wilderness therapy is specifically meant to address trauma
Adventure-based counseling is more clinical in nature
Wilderness therapy is more clinical in nature
Adventure-based counseling is specifically meant to address trauma
Correct answer: Wilderness therapy is more clinical in nature
There are two modalities that tend to use outdoor settings and challenges as their main treatment setting. Adventure-based counseling is a less clinical mode in which participants share a challenge or experience that is mostly meant to build camaraderie and enhance communication. A more clinical option is wilderness therapy, which is specifically meant to treat particular populations such as at-risk adolescents.
Both modalities can deal with trauma, but neither is expressly designed to do so.
Which of the following would be characteristic of a person in the contemplation stage of change?
Talking themselves in and out of going to the gym
Not believing fitness is important
Attending a gym three times a week
Generating a list of gyms to try
Correct answer: Talking themselves in and out of going to the gym
The stages of change model described in the work of Prochaska is a standard way of evaluating where a client is in a change process. The first stage, precontemplation, would be someone who does not believe change is necessary, such as a person who does not believe fitness is important. The next stage of contemplation is characterized by ambivalence, such as a person talking themselves into and out of going to a gym.
The next stage, preparation, would be most like generating a list of gyms to attend or ideas about change. Action would be attending a gym three times a week, and maintenance would be keeping this practice consistent.
Which statement is most consistent with unconditional positive regard?
“I like you no matter what.”
“I support all of your choices.”
“I am here to help you choose.”
“I accept you in all of your complexity.”
Correct answer: “I accept you in all of your complexity.”
In Rogerian therapy, the concept of unconditional positive regard refers to the therapist being accepting of the client as a human being in all of their complexity. This is not the same as liking the client or supporting all of their choices but rather being a nonjudgmental, safe other.
Unconditional positive regard does not involve assisting clients with choices per se.
Which of the following would be the best example of paraphrasing?
Calling the client’s attention to a discrepancy
Putting the client’s feelings in the counselor’s words
Going over what happened at the last session
Bringing in the client’s family to assist with communication
Correct answer: Putting the client’s feelings in the counselor’s words
Several unique communicative skills are valuable in a therapeutic context. One of the main ones is paraphrasing, which amounts to taking input from the client, such as their feelings, and relating it back to the client in the counselor’s words. This is a helpful technique to clarify the client’s feelings and enable more full communication.
Paraphrasing does not apply to calling the client’s attention to a discrepancy, going over what happened in the last session, or bring
Taylor is a young boy who speaks in three-word sentences, such as “I want cookie.” He often refers to any day in the past as “yesterday,” even if the event occurred weeks before. He has an active imagination and has recently developed a fear of monsters in his closet. According to Piaget’s theory of development, what stage of development is Taylor in?
Formal operational
Concrete operational
Preoperational
Sensorimotor
Correct answer: Preoperational
Jean Piaget was a Swiss psychologist and developmental theorist known for his theory of cognitive development. His theory is based on the belief that children learn best through interactions with others, and it breaks down development into sensorimotor, preoperational, concrete operational, and formal operational stages.
During the preoperational stage, which typically occurs between ages two and seven, the child begins to speak in multi-word sentences, expands his or her imagination, engages in symbolic play, and begins to possess a relative sense of time.
The sensorimotor stage occurs during the first two years of life, when children experience the world through crawling and beginning to walk, as well as with their five senses.
The concrete operational stage occurs from age seven to eleven and is marked by an increased ability to think logically and about others’ perspectives.
The formal operational stage is the fourth and final stage and occurs from age eleven through adulthood. During this stage, children develop abstract thought and complex problem-solving skills.
A counselor has a poor relationship with her own father, who tended to be emotionally unavailable and sometimes abusive during the counselor’s childhood. The counselor realizes that she has been particularly irritable during sessions with an older male client who is about her father’s age, and she finds herself getting frustrated with the client when he cannot put his feelings into words.
What is likely taking place in these sessions?
Reaction formation
Countertransference
Regression
Transference
Correct answer: Countertransference
Countertransference, a common occurrence in psychoanalytic counseling, is the projection of the counselor’s feelings and perceptions onto the client. In this situation, the counselor is feeling irritated and frustrated with the client because of characteristics that remind her of her father. The counselor should continue to pay attention to the emotional triggers that occur within that relationship and seek counsel from a colleague or mentor if necessary.
Which of the following would be an example of blocking in the context of group therapy?
The group leader takes action to shape the function of the group
The group as a whole is not making progress on the issue at hand
The group leader stops an interaction that has become an argument
A group member refuses to deal with a significant issue
Correct answer: The group leader stops an interaction that has become an argument
The role of the group leader in group therapy can change from group to group and within the context of an individual group. In some cases, the role calls for intervention when the work of the group has become less productive or when harm could result from a given group process or interaction. This is called blocking, and an example would be stopping a non-therapeutic interaction when it has gone too far.
The other examples address processes by the group or its members or deal with a group leader’s primary role, which is to shape the function of the group. These are not examples of blocking.
According to Eric Berne’s transactional analysis (TA), what is a “life script”?
A life script is a narrative at the end of life about one’s life
A life script is the therapeutic product of TA, helping a client become more truly themselves
A life script is a narrative construction
formed through traumatic circumstances
A life script is a plan developed at an early age that a client follows through life
Correct answer: A life script is a plan developed at an early age that a client follows through life
According to Eric Berne’s Transactional Analysis (TA), a life script is a plan developed at an early age that a client follows through life. In analyzing this script, one can arrive at useful truths about self-concept and relational patterns.
TA does not suggest that the life script is formed through trauma per se, that the life script is a therapeutic product, or that it is an end-of-life narrative activity.
Which of the following is the difference between first- and second-order change?
First-order change refers to change by individuals, while second-order change refers to change in groups
First-order change is more superficial, while second-order change is deeper
Second-order change is more superficial, while first-order change is deeper
First-order change addresses
psychopathology, while second-order change addresses normal function
Correct answer: First-order change is more superficial, while second-order change is deeper
In the language of solution-focused brief therapy (SBFT), a first-order change is superficial and does not lead to lasting change, while a second-order change does lead to more lasting and systemic change.
These terms are not specifically related to psychopathology or group/individual status.
In terms of counseling, what is the difference between sympathy and empathy?
Sympathy places distance between individuals, while empathy encourages engagement
In current counseling practice, the terms are equivalent
Sympathy implies deep understanding, while empathy implies shallow pity
Empathy places distance between
individuals, while sympathy encourages engagement
Correction: Sympathy places distance between individuals, while empathy encourages engagement
In the practice of counseling, it is important to draw a distinction between sympathy and empathy. Sympathy tends to be an expression that places a distance between individuals and is mainly a way to avoid engagement; in most cases, it expresses pity and seeks to end dealing with the presented circumstance. Empathy is an actual engagement with the feelings of the individual and is seen as far more desirable in a therapeutic context.
The terms are not equivalent.
Effective group leaders typically use what level of emotional stimulation?
Very low amounts
Moderately low amounts
Moderate amounts
High amounts
Correct answer: Moderate amounts
Irvin Yalom is well-known for his contributions to the field of group leadership and the various functions that contribute to successful groups. According to Yalom, effective leaders use moderate amounts of emotional stimulation, moderate amounts of executive direction, frequent use of caring functions, and consistent use of meaning attribution.
Which of the following refers to a person’s tendency to be aware of one’s own cognition?
Supercognition
Supracognition
Self-cognition
Metacognition
Correct answer: Metacognition
Metacognition refers to a person’s tendency to be aware of their thoughts. It is a key concept in cognitive therapy, in which the monitoring of one’s thoughts and examination for patterns is central.
Supercognition, supracognition, and self-cognition are all fabricated terms.
Which of the following characterizes the techniques of structural family therapy?
Directive and focused on past contributors to dysfunction
Non-directive and focused on pathology
Abstract and discussion-based
Directive and enacted in the here and now
Correct answer: Directive and enacted in the here and now
Structural family therapy is directive and enacted in the here and now. It explicitly diagnoses and addresses maladaptive family systems through direct participatory observation and changes in the present.
Structural family therapy is not abstract, discussion-based, or focused on the past, nor is it explicitly focused on pathology.
In group counseling, what is the primary purpose of linking?
To develop insight into principles of paraverbal communication
To encourage group members to think critically about their own role in the problem
To stop unproductive behaviors in the group
To facilitate members helping each other with their problems
Correct answer: To facilitate members helping each other with their problems
Group counselors have many responsibilities when leading groups and must have some general knowledge about how to encourage and mediate group dynamics. Linking is the process of looking for common themes in the group content or process and connecting them. This approach can help members work on each other’s problems.
Alan is plagued by intrusive thoughts about his ailing father, about whom Alan feels guilt for various reasons. If Alan engages in the defense mechanism of repression, which of the following is most likely?
Alan will forget about his father
Alan will become hostile toward his father
Alan will contact his father
Alan will speak with others about his father
Correct answer: Alan will forget about his father
Defense mechanisms serve the purpose of alleviating anxiety and protecting the psyche from troublesome or vivid emotions. Repression would most likely make Alan forget about his father, as thoughts about the troublesome stimulus (his father) would be repressed.
Repression would result in an unconscious forgetting or denial of the stimulus or thought, not the urge to contact, discuss, or become hostile toward the stimulus.
Which of the following would be characteristic of a vertical therapeutic relationship?
The therapist is an expert, and the client is receptive
Neither the client nor the therapist assumes a posture of expertise
The therapist and the client share therapeutic expertise
The client is the expert, and the therapist is receptive
Correct answer: The therapist is an expert, and the client is receptive
The status of a therapist and a client is important to consider as part of a therapeutic process. Most models favor some form of a vertical therapeutic relationship, in which the therapist is seen as the expert, and the client is seen as receptive to that expertise. Many models, however, favor a horizontal therapeutic relationship in which neither party is seen as the expert.
A vertical therapeutic relationship does not involve shared expertise or the absence of expertise.
Which of the following describes the interconnectedness of family members’ influences on one another?
Triangulation
Cybernetics
Paradigm shift
Circular causality
Correct answer: Circular causality
Reciprocal determinism is a concept universally understood by family therapists and is the belief that every family member influences every other family member in a continuous process. Circular causality is the belief that forces are moving in many different directions simultaneously, resulting in a complex variety of outcomes. Counselors who focus on circular causality during family sessions focus on the process, not the content. Linear causality refers to the belief that one event or interaction directly causes another, so content and language help explain what is occurring within the family.
Which of the following describes the interconnectedness of family members’ influences on one another?
Triangulation
Cybernetics
Paradigm shift
Circular causality
Correct answer: Circular causality
Reciprocal determinism is a concept universally understood by family therapists and is the belief that every family member influences every other family member in a continuous process. Circular causality is the belief that forces are moving in many different directions simultaneously, resulting in a complex variety of outcomes. Counselors who focus on circular causality during family sessions focus on the process, not the content. Linear causality refers to the belief that one event or interaction directly causes another, so content and language help explain what is occurring within the family.
Which of the following clients would be a good choice for the intervention of rational emotive imagery?
A client who has been deeply depressed for years
A client who is struggling to control their thoughts
A client who has extreme highs and lows of mood
A client who is nervous in interpersonal interactions
Correct answer: A client who is nervous in interpersonal interactions
Rational emotive imagery is a technique often used in rational-emotive behavior therapy (REBT). It involves having the client imagine a threatening circumstance, and then approaching that circumstance with logical thought instead of an emotional response.
Clients who have thought disorders or struggle with mood/depression would be poor choices, unless the focus would be on an individual, threatening life circumstance that would benefit from analysis.
Alan is preparing to treat Amanda, his client who has a phobia of insects. He is weighing the option of in vivo systematic desensitization versus the same modality conducted in a virtual environment.
Which statement is true about the difference in effectiveness between the two types of systematic desensitization?
Physiological reactions are the same in both versions of systematic desensitization
Virtual systematic desensitization has not been shown to be effective
Physiological reactions are higher during virtual systematic desensitization
Physiological reactions are higher during in vivo systematic desensitization
Correct answer: Physiological reactions are the same in both versions of systematic desensitization
The modality of systematic desensitization can be used to describe a graduated form of regulated exposure to a feared stimulus. Research has shown no major difference in physiological reactions between in vivo and virtual versions of this modality.
Virtual systematic desensitization has been shown to be effective.
Which of the following is the proper focus of person-centered counseling?
The person’s essential moral character
The person’s phenomenological world
The person’s inner conflict
The person’s honesty in relationships
Correct answer: The person’s phenomenological world
The school of person-centered counseling as popularized by Carl Rogers focuses on the phenomenological world of the person in counseling. The emphasis is on helping the person reach a self-actualized, personally meaningful existence.
Person-centered counseling would not focus on inner conflict, honesty in relationships, or the person’s essential moral character.
Which of the following would not be characteristic of a Transactional Analysis Group?
Content including dynamic ego states
Leader-centered
A focus on A-B-C theory
A focus on being free of scripts and games
Correct answer: A focus on A-B-C theory
Transactional Analysis Groups focus on the study and repair of the pattern of one’s interpersonal interactions, with a focus on being free of scripts and games. Transactional Analysis includes content based on dynamic ego states (parent, adult, and child), and is leader-centered in its character.
The A-B-C theory is used in Rational Emotive Behavior therapy.
Which of the following is the goal of systematic desensitization techniques?
To substitute a troublesome stimulus with a desirable one
To train resistance to negative
assessments of others
To increase receptivity to appropriate stimuli
To reduce or extinguish the effect of a trouble
extinguish the effect of a troublesome stimulus
Systematic desensitization is a technique designed to reduce or extinguish the effect of a troublesome stimulus by some form of mitigated exposure to increasingly tolerable levels of the troublesome stimulus. For example, a person who is afraid of spiders might first have a conversation about spiders, then see pictures, and at some later stage be exposed to a live spider.
The goal of systematic desensitization is not to increase receptivity to any stimuli or substitute one stimulus for another. It is not meant to train resistance to interpersonal assessment.
According to the Global Scale for Rating Helper Responses, which of the following would be considered the worst score?
1.0
2.0
3.0
4.0
Correct answer: 1.0
The Global Scale for Rating Helper Responses was designed to assess counselor skills and point out directions in which they could be built. This scale is scored from 1.0 to 5.0, with 1 indicating that a counselor is non-empathic, scolding, and otherwise not attending to a client’s needs, and 5.0 indicating a full understanding of all levels of client needs and an ability to facilitate growth.
During a group counseling session about sexuality issues, group members discuss the differences between male and female stereotypes. One group member comments that she disagrees with some of these stereotypes. Several of the other members quickly begin to criticize her statements and make rude comments about her appearance and intelligence, requiring the counselor to intervene. These group members were:
blocking
linking
scapegoating
intellectualizing
Correct answer: scapegoating
Scapegoating occurs when several group members target an individual member of the group and criticize that person. This is a normal group process, but one that should not be tolerated due to its potential for damaging relationships.
Intellectualizing is the process of keeping group content on a cognitive, rather than emotional, level. Blocking and linking are responsibilities of the group leader that are meant to encourage group cohesion and constructive discussion.
In the language of group therapy, which of the following would be considered a vertical intervention?
Having a group member be the focus of a session
Having the group itself be the focus of a session
Having two group members focus on each other in a session
Having a specific diagnosis be the focus of a session
Correct answer: Having a group member be the focus of a session
Group therapy involves a wide variety of specific skills and interventions. Some of these more specifically address an individual, making them the focus of a session or given intervention; these are called vertical interventions. Horizontal interventions would involve all the members of the group.
A group can deal with itself, target a specific diagnosis, and split into subgroups without practicing vertical intervention.
Which of the following statements is most accurate regarding defense mechanisms?
They are unconscious processes that protect the conscious
They are conscious processes that expand emotional expression
They are conscious processes that protect the unconscious
They are unconscious processes that expand emotional expression
Correct answer: They are unconscious processes that protect the conscious
Defense mechanisms are unconscious processes that protect the conscious. This is done by resolving, deflecting, dismissing, or otherwise short-circuiting the problematic stimuli or thought processes in the unconscious mind. In this way, the mind is protected from conflict and threats to its equilibrium.
Defense mechanisms do not expand emotional expression per se.
Which of the following would be consistent with Gestalt therapy?
“What is the most important relationship in your life?”
“What are you feeling right now?”
“What is your most painful memory?”
“Tell me about your family of origin.”
Correct answer: “What are you feeling right now?”
Fritz Perls’ Gestalt therapy is a here-and-now focused, experiential school of therapy that attempts to focus the client on present circumstances and their own responsibility. One of its techniques is to use here-and-now questions to enhance a focus on the present.
The other questions deal too much with the past and abstraction to be characteristic of Gestalt.
The belief that factors such as altruism, universality, interpersonal functioning, imitative behavior, group cohesiveness, catharsis, and corrective recapitulation of the primary family groups contribute to successful group functioning was posited by whom?
Tuckman
Yalom
Corey
Satir
Correct answer: Yalom
Irvin Yalom is well-known for his contributions to the field of group counseling. He developed a list of eleven curative factors that he believes exist in successful group work. These include altruism, universality, interpersonal learning, imparting information, developing socialization techniques, imitative behavior, group cohesiveness, catharsis, corrective recapitulation of the primary family group, instillation of hope, and existential factors. Yalom believes that if these factors are present in a group, group members will grow and develop.
According to rational emotive behavior therapy (REBT), when do we learn irrational beliefs?
In childhood
In adolescence
As a result of abnormal brain development
As a result of trauma
Correct answer: In childhood
REBT focuses on the identification and correction of false interpretive beliefs about reality. These false beliefs emerge, according to REBT, in childhood. They are reinforced throughout subsequent life and become concretized in the personality.
REBT does not suggest that irrational beliefs are a result of trauma, emerge in adolescence, or result from abnormal brain development.
Which of the following would be the most likely use of biofeedback in behavior therapy?
Enhance a client’s control of their unconscious
Enhance a client’s control of their circumstances
Enhance a client’s control of their body
Enhance a client’s control of their behavior
Correct answer: Enhance a client’s control of their body
One well-known behaviorist technique is biofeedback, which involves the client enhancing their control of their body in some way. This generally refers to a client being able to more productively interact with their autonomic nervous system, (e.g., to control their heart rate in response to stress).
Biofeedback does not have to do with control of behavior per se, nor does it address a client’s unconscious or their circumstances.
Which of the following would be the most likely use of biofeedback in behavior therapy?
Enhance a client’s control of their unconscious
Enhance a client’s control of their circumstances
Enhance a client’s control of their body
Enhance a client’s control of their behavior
Correct answer: Enhance a client’s control of their body
One well-known behaviorist technique is biofeedback, which involves the client enhancing their control of their body in some way. This generally refers to a client being able to more productively interact with their autonomic nervous system, (e.g., to control their heart rate in response to stress).
Biofeedback does not have to do with control of behavior per se, nor does it address a client’s unconscious or their circumstances.
Which of the following is humans’ essential problem, according to Rational emotive behavior therapy (REBT)?
Our dysfunctional personalities
Our traumatized childhood
Our inner conflict
Our interpretation of events
Correct answer: Our interpretation of events
According to the beliefs of rational emotive behavior therapy (REBT), our essential problem is not our experience of events but our interpretation of events. We abandon rational thinking in favor of our own irrational interpretation of events.
The problem, according to REBT, is not our traumatized childhood, inner conflict, or dysfunctional personalities.
n his book The Seasons of a Man’s Life, Daniel Levinson presents his Stage-Crisis View theory, which examines the typical periods in a man’s life. What does Levinson say about midlife crises?
They are part of normal, healthy development
They are often the main cause of divorce and other relationship disruptions
They are social constructs that must be avoided
Correct answer: They are part of normal, healthy development
Daniel Levinson was a 20th-century American psychologist whose studies focused on typical stages in his adult subjects’ lives. Levinson’s Stage-Crisis View theory posits that there are predictable, stable, and transitional periods in life and that the social conflicts that arise during these periods must be resolved. He proposed that midlife crises are not only common but are part of normal, healthy development.
A group member talks about a recent interaction he had that led him to wonder about how he is perceived by others. Later in the session, another member says, “No one knows what it’s like to be me.” The group counselor comments that this is similar to the first group member’s thoughts earlier in the session. The technique used by this counselor is known as:
blocking
triangulating
linking
Correct answer: linking
In group counseling, linking is the process of relating group members’ thoughts, comments, and feelings to each other to increase cohesion and (at times) interaction. Linking is one of many techniques group counselors can use to enhance group members’ experiences and to effect change.
In successful groups, what are the three distinct sections of each group counseling session?
Confinement, sharing, and closure
Basic, advanced, and termination
Self, others, and group
Warm-up, action, and closure
Correct answer: Warm-up, action, and closure
There are many group dynamic issues for counselors to remember in terms of group content and process. The content and process are often organized into three distinct group sections: warm-up, action, and closure. In well-functioning groups, there is a smooth transition from one section to the next, and there is a balance between content and process in each section.
Some counselors use the process of circular questioning, which is when different family members are asked the same questions about the same relationships. This approach is used most often in conjunction with which family therapy approach?
Milan systemic family therapy
Narrative family therapy
Strategic family therapy
Structural family therapy
Correct answer: Milan systemic family therapy
Milan systemic family therapy refers to an approach that views the family as a system that aims to maintain balance. Systemic family therapists often use a variety of techniques, including circular questioning, which is the process of asking different family members the same questions about relationships. The family counselor can then use the ways that members differ in how they interpret events and interactions to suggest new ways of thinking about things, thereby hopefully changing family rules and relationships.
What distinguishes flooding from other types of desensitization strategies?
Flooding can only be used in cases of severe trauma
Flooding does not involve exposure to a feared stimulus
Flooding is mostly used for mood-disordered clients
Flooding involves actual exposure to a feared stimulus
Correct answer: Flooding involves actual exposure to a feared stimulus
Desensitization strategies are designed to reduce the anxiety that occurs when a person is exposed to a feared stimulus, as in the case of a phobia. The technique of flooding differs from other, more gradual applications of this strategy by making the exposure to the feared stimulus total and immediate.
Flooding is not necessarily indicated or contraindicated for persons with severe trauma and mood disorder. Its suitability depends on how the counselor evaluates their possible success with this technique in response to a feared stimulus.
Which of the following is false about crisis intervention?
It follows a stepwise intervention model
It is meant to address psychopathology
It is limited in time
It is meant to address the normal process of crisis
Correct answer: It is meant to address psychopathology
Crisis intervention is a specific modality meant to address the normal process of crisis, which can be stressful and debilitating. This process goes through various stages from establishing the safety of the client to the use of new skills and is limited in scope to the crisis itself.
Crisis intervention is not meant to address psychopathology but to enhance function during a challenging but normal time.
Which of the following is false about crisis intervention?
It follows a stepwise intervention model
It is meant to address psychopathology
It is limited in time
It is meant to address the normal process of crisis
Correct answer: It is meant to address psychopathology
Crisis intervention is a specific modality meant to address the normal process of crisis, which can be stressful and debilitating. This process goes through various stages from establishing the safety of the client to the use of new skills and is limited in scope to the crisis itself.
Crisis intervention is not meant to address psychopathology but to enhance function during a challenging but normal time.
Which of the following would be characteristic of the preparation stage of change?
Trying to figure out whether one wants to change
Being unaware that change is necessary
Taking the beginning steps of change
Coming up with a list of options
Correct answer: Coming up with a list of options
Prochaska postulated a structured, stepwise model of change that is widely used in therapeutic contexts. It contains five stages. The first, precontemplation, is one in which a person may or may not know they need to change. The second, contemplation, is when a person is most ambivalent about whether to change.
Preparation, as seen in this example, is when a person is gathering resources and information for change. Action is the stage in which change begins, and maintenance is the habitual realization of the changes that have begun.
oe has been struggling with fear of the dark since he was a child. He is engaging in a systematic desensitization strategy. He has learned to control his physical responses to the dark and, with the help of his therapist, has found a way to intellectualize the various levels of his fear of the dark.
Which of the following would happen next?
Learning how to control responses to a dark room
Going into a dark room
Thinking about what is most fearful about a dark room
Imagining being in a dark room
Correct answer: Imagining being in a dark room
Systematic desensitization deals with a person’s systematically reduced anxiety when exposed to a certain stimulus. It is generally seen as proceeding through four stages.
Relaxation training to gain control of one’s responses
Construction of anxiety hierarchy to gain intellectual knowledge of one’s fear
Imaginative desensitization to explore one’s fear in safe circumstances
In vivo sensitization to gain control over the feared stimulus
The progression is necessarily stepwise and iterative. In this case, the first two steps have been done, so the next step would be the imaginative exercise of imagining being in a dark room.
Going into a dark room would be the last stage. Learning how to control responses and thinking of what is most fearful about a dark room would have been accomplished earlier in the process.
oe has been struggling with fear of the dark since he was a child. He is engaging in a systematic desensitization strategy. He has learned to control his physical responses to the dark and, with the help of his therapist, has found a way to intellectualize the various levels of his fear of the dark.
Which of the following would happen next?
Learning how to control responses to a dark room
Going into a dark room
Thinking about what is most fearful about a dark room
Imagining being in a dark room
Correct answer: Imagining being in a dark room
Systematic desensitization deals with a person’s systematically reduced anxiety when exposed to a certain stimulus. It is generally seen as proceeding through four stages.
Relaxation training to gain control of one’s responses
Construction of anxiety hierarchy to gain intellectual knowledge of one’s fear
Imaginative desensitization to explore one’s fear in safe circumstances
In vivo sensitization to gain control over the feared stimulus
The progression is necessarily stepwise and iterative. In this case, the first two steps have been done, so the next step would be the imaginative exercise of imagining being in a dark room.
Going into a dark room would be the last stage. Learning how to control responses and thinking of what is most fearful about a dark room would have been accomplished earlier in the process.
What is a goal that group members of a person-centered group may have?
Become free of scripts and games
Increase self-acceptance and move past self-defeating behaviors
Take responsibility for one’s life
Increase self-understanding and explore a full range of feelings
Correct answer: Increase self-understanding and explore a full range of feelings
Person-centered groups typically encourage openness and an exploration of a full range of feelings. Techniques include active listening and reflection rather than structured techniques found in other types of groups. The focus of person-centered groups is on increasing self-understanding and personal insight.
Which of the following accurately states the stages of Meichenbaum’s stress inoculation technique?
Precontemplation, rehearsal, action
Education, rehearsal, action
Education, rehearsal, application
Education, action, maintenance
Correct answer: Education, rehearsal, application
Meichenbaum developed a three-stage stress inoculation technique that is meant to help one know and reduce one’s own stress.
The first stage, education, helps the client understand how they respond to stress through inner dialogue. The second, rehearsal, is when new strategies of self-talk are used. The third, application, is when the new self-talk is used in practice
In what type of situation is autocratic leadership the best option?
A closed group that does not allow
changes to membership
A group that only meets for four sessions
A group made up of motivated and self-directed members
A group whose members have many differing ideas
Correct answer: A group that only meets for four sessions
Group counselors can choose from one of three main styles of leading groups: autocratic, democratic, and laissez-faire. Autocratic leaders are typically direct and set clear goals and boundaries for groups. This type of leadership works best when time restraints are an issue, when membership frequently changes, or when the group needs to coordinate with other groups. Democratic leaders allow members to express their ideas and aim to encourage discussion and participation. Laissez-faire leaders allow group members to be in charge of all decision-making and it works best when group members are very motivated.
Which of the following would be an example of implosive therapy?
A client bringing their partner to therapy to explore their conflict
A client being forced to examine their life choices critically
A client being asked to relive their crisis in the therapist’s office
A client with a fear of flying imagining a plane crash in the therapist’s office
Correct answer: A client with a fear of flying imagining a plane crash in the therapist’s office
Implosive therapy is a behaviorist technique meant to desensitize a client to a feared stimulus. One example would be a client with a fear of flying imagining a plane crash in the safe environment of a therapist’s office. This would likely be followed by more iterations with the goal of reducing experienced distress.
Implosive therapy generally does not involve others, nor would it usually ask a client to critically examine their life choices. It would most likely not ask a client to relive a crisis unless that crisis was in some way a current source of fear or distress.
Which of the following would be an example of implosive therapy?
A client bringing their partner to therapy to explore their conflict
A client being forced to examine their life choices critically
A client being asked to relive their crisis in the therapist’s office
A client with a fear of flying imagining a plane crash in the therapist’s office
Correct answer: A client with a fear of flying imagining a plane crash in the therapist’s office
Implosive therapy is a behaviorist technique meant to desensitize a client to a feared stimulus. One example would be a client with a fear of flying imagining a plane crash in the safe environment of a therapist’s office. This would likely be followed by more iterations with the goal of reducing experienced distress.
Implosive therapy generally does not involve others, nor would it usually ask a client to critically examine their life choices. It would most likely not ask a client to relive a crisis unless that crisis was in some way a current source of fear or distress.
Which of the following would be the most likely use of the empty chair technique?
To address trauma by reliving past events
To overcome fear through exposure
To help a person explore their feelings about another
To allow the therapist and the client to switch roles
Correct answer: To help a person explore their feelings about another
The empty chair technique is used often in various models of therapy. It involves an empty chair in which the client imagines another person to be. That person will be someone that the client will benefit from “talking to” in this manner and can aid in clarifying and exploring feelings about another.
The technique does not involve switching roles and is more geared toward the exploration of a relationship than overcoming fear or addressing trauma.
Which of the following would be the most likely use of the empty chair technique?
To address trauma by reliving past events
To overcome fear through exposure
To help a person explore their feelings about another
To allow the therapist and the client to switch roles
Correct answer: To help a person explore their feelings about another
The empty chair technique is used often in various models of therapy. It involves an empty chair in which the client imagines another person to be. That person will be someone that the client will benefit from “talking to” in this manner and can aid in clarifying and exploring feelings about another.
The technique does not involve switching roles and is more geared toward the exploration of a relationship than overcoming fear or addressing trauma.
Which of the following statements would be characteristic of choice theory?
“Let’s discuss where this pain started for you.”
“What are you going to do to address this problem?”
“If you could change everything overnight, what would it look like tomorrow?”
“How does your family feel about this?”
Correct answer: “What are you going to do to address this problem?”
Choice theory asserts that the most important driver of patient wellness is the patient’s behavioral choices in the here and now. Like other therapeutic orientations that focus on the responsibility taken and used by the client, choice theory is mainly concerned with the present and not with the past exploration of causal elements of present issues.
The other statements do not suggest a present orientation focused on patient choices in reality.
Which of the following was the initial focus of dialectical behavioral therapy (DBT)?
Patients with schizophrenia and obsessive-compulsive personality disorder
Aggressive patients and those with borderline personality disorder
Patients with schizophrenia and paranoid personality disorder
Suicidal patients and those with borderline personality disorder
Correct answer: Suicidal patients and those with borderline personality disorder
Dialectical behavioral therapy (DBT) is a treatment modality first used to address suicidal patients and those with borderline personality disorder. It has a substantial evidence base and is now used to treat a variety of other issues.
DBT involves skills training, individual treatment, and a high degree of contact with the therapist. It is considered a cognitive behavioral method.
In which of the following group stages is conflict most likely to occur?
Orientation
Working
Termination
Transition
Correct answer: Transition
Group work is generally conceptualized to follow a four-stage process. In the first stage, orientation, the group is formed and acquainted. The next stage, transition, is when interpersonal dynamics are worked out and conflict is most likely to occur. When this is resolved, the working phase can begin. When the work is complete, it is appropriate to measure progress in the termination stage.
Which of the following describes the proper use of silence in a therapeutic session?
It can only be used with clients who present with mood difficulties
It is helpful to elicit client responses
It is threatening to clients and should be avoided
It should only be used with certain types of clients
Correct answer: It is helpful to elicit client responses
Though it can be uncomfortable for clients and therapists and should be carefully applied, the use of silence in therapy sessions is a widely known and useful counseling practice. There are several benefits to silence, including allowing for greater control of the session’s emotional level, giving control to the client, and forming a space in which a client has time to find the best response to a therapeutic direction or idea.
Silence can be mildly uncomfortable but should not be threatening if properly used. There is no directive as to which clients are more or less able to benefit: it is a tool to be carefully applied like any other with a variety of clinical presentations.
