Psicoterapia Flashcards
23.1.
Which scenario would make a patient a good candidate for
psychoanalysis?
A. A diagnosis of a new medical condition
B. An absence of suffering
C. Having a high frustration tolerance
D. Possessing an urgent need for symptom relief
E. Undergoing a high-conflict divorce
23.1. C. Having a high frustration tolerance
Good candidates for psychoanalysis must truly wish to understand
themselves and not need urgent symptom relief. Being able to
withstand frustration and anxiety without acting out are important
characteristics to possess in order for psychoanalysis to be
successful. Some level of suffering is needed for the therapy to be
effective. Antisocial personality disorder, low intelligence, and being
in the middle of a major life crisis (i.e., divorce or loss of a job or
being diagnosed with a major medical condition) are all potential
contraindications to psychoanalysis.
23.2.
A 30-year-old healthy, bright male who works as an attorney
has had a series of few long-term failed romantic relationships
over the past few years and has been feeling chronically
depressed and anxious due to the loneliness and work stress.
He has had increasing struggles with sleeping and focusing
due to obsessive thoughts about his failures in life and most
recently when dating someone new reported being distressed
by sexual dysfunction. He has no history of suicidal thoughts
or self-harm. He is willing to make a long-term commitment to
treatment this time. He would be a good candidate for which
of the following types of psychotherapies?
A. Cognitive therapy
B. Couples therapy
C. Dialectical behavioral therapy
D. Exposure and response prevention
E. Psychoanalysis
23.2. E. Psychoanalysis
Health, intelligence, good financial means, and being able to commit
to long-term treatment are some factors which can lead to success in
psychoanalysis. An absence of need for urgent symptom relief and a
lack of safety concerns would also make this patient a good
candidate. Psychanalysis is suitable for those with depression,
anxiety, sexual dysfunction, and some personality disorders, along
with those with chronic suffering, as described in the case
23.3.
A patient expressing, “cabbages to kings” during a therapy
session is a good example of which fundamental technique in
psychoanalysis?
A. Free association
B. Psychotic ramblings
C. Reaction formation
D. Suspended attention
E. Working through
23.3. A. Free association
Free association is a predominant technique in psychoanalysis. The
fundamental rule of free association is for the patient to tell the
analysis everything that comes to their mind, the unimportant and
nonsensical, and it does not mirror normal conversation. A
conversation leading from, “cabbages to kings” is a good example of
free association
23.4.
Which is a strategy that is utilized in psychoanalytic
psychotherapy more heavily as compared to psychoanalysis?
A. A focus on memory recall
B. A longer treatment time frame
C. Face-to-face sessions
D. Suspended attention
E. Use of free associations
23.4. C. Face-to-face sessions
Psychoanalytic psychotherapy is derived from psychoanalysis. It uses
insight-oriented methods such as expressive techniques along with
supportive ones. It is shorter compared to psychoanalysis and the
brief treatment is focused on a select problem. Instead of utilization
of the couch, sessions are done with the therapist and patient looking
at one another face-to-face to help prevent regression and to aid with
receiving cues. Free association is rarely used.
23.5.
Expressive psychotherapy is different from psychoanalysis in
which of the following ways?
A. A focused understanding of problems is achieved by
modifying ego function
B. Deeply hidden and past motives are discovered early in
treatment
C. Insight through a genetic level is sought
D. Motives and interactions are traced all the way back
through infancy
E. Positive transference and regression are more heavily
explored
23.5. A. A focused understanding of problems is achieved
by modifying ego function
While both expressive psychotherapy and psychoanalysis increase
awareness, expressive psychotherapy does so by improving object
relationship and exploring current interpersonal events. Structural
changes in ego function and defenses are achieved in expressive
psychotherapy. Unlike psychanalysis which uncovers hidden and
past motives dating back to origins in infancy, expressive
psychotherapy focuses on how the preconscious or conscious
conflicts manifest in the present day
23.6.
A 40-year-old woman was just recently diagnosed with
cancer and has minimal time, struggling between being
compliant with medical treatments, managing her job, and
caring for her kids. She expresses concern about having the
time and money for therapy. She feels that her life was great
prior to her cancer diagnosis and is hoping the symptoms will
pass on their own. Her oncologist is concerned about her
missing appointments and that she struggles with getting out
of bed and caring for herself. Upon expressing feelings of
hopelessness, her oncologist encourages her to start therapy
though she remains skeptical. Which therapy is she best suited
toward?
A. Cognitive behavioral therapy
B. Expressive psychotherapy
C. Interpersonal psychotherapy
D. Psychodynamic psychotherapy
E. Supportive psychotherapy
23.6. E. Supportive psychotherapy
Supportive psychotherapy focuses on external rather than
intrapsychic events and on how stressful environmental and
interpersonal influences can damage the self. It is useful for those
patients with poor ego strength, who are in an acute crisis. Those
who are medically ill and/or cognitively limited, or unmotivated and
are looking for immediate symptom relief are good candidates for
supportive psychotherapy
23.7.
Group therapy would be contraindicated for a patient in
which of the following scenarios?
A. A new diagnosis of paranoid schizophrenia with active
delusions
B. A patient actively engaged in individual therapy, suffering
from depression and suicidal thoughts
C. Bipolar disorder with manic symptoms has been diagnosed,
though the patient is stable on medications
D. The patient has antisocial personality disorder and is with
others in the group with the same diagnosis
E. The patient is suffering from an acute grief reaction after
the death of a spouse
23.7. A. A new diagnosis of paranoid schizophrenia with
active delusions
There are relatively few contraindications to participating in group
therapy. A patient with active delusions, who incorporate the group
into the delusions, and a patient who is threatening with frequent
outbursts are some examples of patients who should be excluded
from the group setting. Bipolar disorder, or mania, is not
contraindication to group therapy if manic symptoms are controlled
on medication. Those patients with depression and suicidal thoughts
can benefit from group therapy. However, if any acute safety
concerns are present, individual treatment should be conducted as
well. Those with antisocial personality disorder might struggle in a
group setting unless other patients with the same diagnosis are in the
group, since these patients are thought to respond better to their
peers than authority figures
23.8.
A family has started therapy together for help in managing
one of their children with attention-deficit/hyperactivity
disorder (ADHD), oppositional defiant disorder (ODD), and
worsening behavior problems. The patient is being bullied in
school and the therapist externalizes the problem and helps
the family to focus on the outside stressors and diagnoses.
Each family member writes a therapeutic letter to another
family member in hopes of resolving the conflict within the
family and enhancing insight about the story that each
member is going through. Which school of family therapy is
most likely being employed?
A. Cognitive behavioral
B. Experiential-humanistic
C. Integrative
D. Narrative
E. Psychodynamic
23.8. D. Narrative
Narrative family therapy involves resolution of a presenting problem
through focusing on outcomes and externalizing the problem and
helping the family members to create new meaning via “restorying.”
Therapeutic letters are often written to one another as part of the
therapeutic process. Cognitive behavioral family therapy focuses on
communication and problem solving and change, along with
acceptance and helping members to learn reattribution techniques.
Experiential-humanistic therapy focuses on increasing
differentiation and on detriangulation by using genograms and the
therapist acts as a coach. Integrative family therapy combines
cognitive behavioral and psychodynamic methods
to improve
communication and problem solving. Psychodynamic family therapy
aims to improve insight and enhance empathy by analyzing
transference, countertransference, and resistance and relies on
interpretation and emphasizes the therapeutic alliance
23.9.
During a family therapy session, a mother comments that
their daughter acts like a monster, screaming, hitting them,
and throwing things each morning when trying to get her
dressed to go to school. The therapist comments that she acts
out due to severe social anxiety and struggles with transitions,
and then points out that mother has done a great job at
handling her daughter’s anxiety in the past when she realizes it
is occurring. The therapist also highlights that the child’s
perseverance helps her to get good grades in school and that
her anxious temperament has helped her to be empathic and a
good friend to her sibling.
A. Clarification
B. Family management
C. Paradoxical intervention
D. Reframing
E. Unbalancing
23.9. C. Reframing
This is an example of a therapist using a technique called reframing.
It is also known as positive connotation and involves relabeling of all
negatively expressed feelings or behaviors as positive. It helps the
family member to have a new frame of reference and can lead to
change.
23.10.
A 20-year-old female has seen multiple therapists over the
past few years, noting none of them were helpful and they all
offended her. She continues to struggle with depression, poor
social relations, lack of ability to maintain a job or
relationship, and intermittent self-harm and suicidal
thoughts. Which psychosocial treatment has the most
empirical support to help her?
A. Acceptance and commitment therapy
B. Cognitive behavioral therapy
C. Dialectical behavior therapy (DBT)
D. Insight-oriented psychotherapy
E. Interpersonal psychotherapy
23.10. C. Dialectical behavioral therapy (DBT)
The patient described above most likely has borderline personality
disorder (BPD). DBT is the gold standard to help those with BPD live
a life worth living and can help with self-injurious and parasuicidal
behavior. DBT includes individual, group, telephone, and team
consultation, and helps increase skillful behavior, improve
motivation for changing maladaptive behaviors, and improve
emotional dysregulation.
23.11.
Which type of therapy asks patients to direct their attention
to specific body area while thinking certain phrases reflecting
a relaxed state, progressing through various themes
including cardiac regulation and breathing adjustment?
A. Applied tension
B. Autogenic training
C. Biofeedback
D. Progressive muscular relaxation
E. Relaxation therapy
23.11. B. Autogenic training
Autogenic training can help with relaxation by having the patient
direct attention to specific body areas and think phrases to help them
relax (i.e., My forehead is cool.). The patient progresses through six
themes including heaviness, warmth, cardiac regulation, breathing
adjustment, solar plexus, and forehead. Applied tension involves
tensing the muscles and releasing them, but not to the point of
relaxation. It can help with situations such as fainting. Progressive
muscular relaxation involves tensing and then relaxing the muscles
working the way up the body. Relaxation therapy involves
immobilizing the body, drawing focus and attention, and cultivating
a nonjudgmental, contemplative state of mind. Biofeedback involves
the recognition and display of small changes in physical levels (i.e.,
electromyography [EMG], electroencephalography [EEG]
monitoring) to help bring the autonomic nervous system under
voluntary control through operant conditioning
23.12.
A patient being treated for anxiety and depression tells the
therapist about how embarrassed she was in forgetting the
words for her class presentation today and states that she
knows she will never make it as a teacher in the future. This
is an example of which of the following cognitive distortions?
A. All-or-nothing thinking
B. Labeling
C. Mind reading
D. Overgeneralization
E. Tunnel vision
23.12. D. Overgeneralization
Cognitive distortions, also known as automatic thoughts, are the
thoughts that occur between external events and a person’s
emotional reaction to the event. The vignette above is an example of
overgeneralization in which an overwhelmingly negative conclusion
is drawn from a relatively minor event. All-or-nothing thinking is
also known as black-and-white thinking and involves putting a
situation into only two categories instead of on a continuum or
seeing the gray area in the middle. Labeling is putting a fixed label on
yourself or others without examining the evidence fully which could
lead to a less disastrous conclusion. Mind reading involves believing
you know what others are thinking and not considering more likely
possibilities. Tunnel vision involves seeing only the negative aspect
of a situation.
23.13.
Scheduling activities on a daily basis, keeping records, and
performing mastery ratings are first steps in which of the
following types of treatment for depression?
A. Brief supportive psychotherapy
B. Cognitive behavioral therapy
C. Dialectical behavioral therapy
D. Interpersonal psychotherapy
E. Narrative psychotherapy
23.13. B. Cognitive behavioral therapy
Behavioral techniques can help challenge maladaptive cognition.
One of the first behavioral techniques in cognitive therapy for the
treatment of depression is to have the patient schedule activities on
an hourly basis and keep records of them and rate mastery and
pleasure. Often, this leads the patient to realize they had more
pleasure than they thought while doing the activity and it helps them
to experience a sense of mastery.
23.14.
A patient is being treated for a severe phobia of needles.
Teaching the patient relaxation strategies, while showing
pictures of needles, working toward having them see an
actual needle in the office, and then getting a shot at the
doctor while experiencing minimal anxiety, is an example of
which of the following types of therapies?
A. Aversion therapy
B. Biofeedback
C. Flooding
D. Participant modeling
E. Systematic desensitization
23.14. E. Systematic desensitization
Systematic desensitization is the behavioral principle of
counterconditioning, which helps the patient to overcome anxiety by
gradually exposing them to the feared situation while they learn to be
in a state that inhibits anxiety, called reciprocal inhibition.
Relaxation training, hierarchy construction, and desensitization of
the stimulus are the steps in systematic desensitization. It is
commonly used to treat phobias, obsession or compulsions, and
some sexual disorders as well.
23.15.
A therapist is helping to treat agoraphobia in a child by
accompanying them to a crowded playground to help them
unlearn the fears by observing the therapist having fun at the
playground with other children. This is an example of which
of the following types of therapies?
A. Applied relaxation
B. Behavioral activation
C. Cognitive therapy
D. Participant modeling
E. Social skills training
23.15. D. Participant modeling
Just as a person can develop fears by learning, the principle of
participant modeling is that these fears can be unlearned by
observing a fearless model confront the feared object. In participant
modeling, the patient can learn a new behavior by imitation by
observation, without having to perform the behavior until they feel
ready. Children respond well to this technique of watching other
peers enjoy a feared situation and it is particularly useful therapy for
agoraphobia when the therapist accompanies the patient to various
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