PsychoDyn/Supporitve

Question 1

25 y/o single African-American man, who is a first year law student at an ivy league school, seeks psychotherapy for what he calls “academic paralysis.” He is falling behind as he spends more time brooding about the racial and socioeconomic differences between himself and his classmates. He feels comfortable with his African American psychiatrist and speaks openly about her racial slights that he experiences every day. The most important goal of dynamic psychotherapy with this pt is to: (2x)

Answer 1

USE THE SHARED ETHNIC BACKGROUND TO OFFER INSIGHT TO EXPLAIN HOW THE PT’S ALIENATION MAY BE ROOTED IN SOMETHING MORE THAN HIS CURRENT SITUATION

Question 2

A highly motivated patient in psychodynamic psychotherapy finds that he has nothing to say, which is an example of: (2x)

Answer 2

RESISTANCE

Question 3

This treatment goal is most specific to psychoanalytic psychotherapy: (x2)

Answer 3

BRINGING UNCONSCIOUS CONFLICT INTO AWARENESS

Question 4

College student with good grades needs repeated reassurance. What core belief might the student have?

Answer 4

I CANNOT BE TRUSTED TO MAKE A GOOD DECISION

Question 5

A 3 yo child has been expressing angry feelings about the arrival of a new sibling. The child has a secure attachment to parents as well as grandparents who visit frequently. During one such visit, during which the grandparents spend time holding the new baby, the child begins to bang the head rhythmically against a table. According to psychoanalytic theory, this behavior is understood as which of the following?

Answer 5

TURNING AGAINST THE SELF AS A DEFENSE AGAINST INTOLERABLE ANGER.

Question 6

What best describes current psychoanalytic thinking about the source of countertransference phenomena in the therapist

Answer 6

THE THERAPISTS TOTAL EMOTIONAL REACTION TO THE PATIENT

Question 7

36 y/o pt is beginning psychodynamic psychotherapy for tx of long- standing problems of inability to establish satisfying ongoing relationships. Pt expresses much skepticism that “talking about my past” will help. The most appropriate response of therapist is:

Answer 7

EXPLORE THE PROCESS DURING THE SESSION THAT MIGHT BE INTERFERING WITH THE ESTABLISHMENT OF THE THERAPEUTIC ALLIANCE

Question 8

Which psychotherapy uses transference interpretations and clarification to develop insight and resolve conflict?

Answer 8

PSYCHODYNAMIC PSYCHOTHERAPY

Question 9

In the context of the psychodynamic psychotherapy, the term “frame” refers to which of the following aspects of therapy?

Answer 9

HOW IT IS ORGANIZED IN TERMS OF BOUNDARIES AND CONSISTENT DEFINING RULES

Question 10

Intensive, short-term dynamic psychotherapy is contraindicated for what condition?

Answer 10

ACUTE EXACERBATION OF CHRONIC SCHIZOPHRENIA

Question 11

Use of meds with psychodynamic psychotherapy optimal when:

Answer 11

MEANINGS AND EFFECTS OF MEDS INTEGRATED INTO PT’S UNDERSTANDING

Question 12

In split treatment, the role of the prescribing psychiatrist is?

Answer 12

EVALUATE THE PTS NEEDS FOR MEDICATIONS WHILE MAINTAINING REGULAR CONTACT WITH THE THERAPIST

Question 13

Psychotherapy research shows which of the following practices in a therapeutic relationship is most supportive for improving outcomes?

Answer 13

COLLECTING FEEDBACK FROM THE PT ABOUT THE TREATMENT

Question 14

Pt receiving weekly brief psychodynamic psychotreatment. 2 months into tx pt acknowledges being aware of maladaptive behaviors, reports now being able to remove himself from situations that frustrate him. The pt’s account is reflective of which of the following elements of brief psychodynamic psychotherapy?

Answer 14

DISCREPANCY

Question 15

When practicing Davanloo’s short-term dynamic psychotx, one must consistently

Answer 15

CLARIFY AND RELENTLESSLY CONFRONT THE PT’S DEFENSES

Question 16

25 y/o F never on a date after 6 mo of psychodynamic psychotherapy. Began to struggle w/ positive feelings about M therapist that she finds hard to accept. At the same time she starts to date. Therapist believes it is transference. Therapist said nothing, he believed an interpretation might interfere w/ positive learning experience. This is example of:

Answer 16

A PRACTICAL/SUPPORTIVE APPROACH

Question 17

Which of the following characteristics is common to all brief dynamic psychotherapies?

Answer 17

PRACTICAL WORKING THROUGH OF CONFLICT BY TRANSFERENCE INTERPRETATION

Question 18

Determines if pt has ego strength for therapy

Answer 18

ASSESSMENT OF QUALITY OF RELATIONSHIPS

Question 19

Goals of brief psychodynamic psychotherapy compared to long-term psychodynamic psychotherapy differ how

Answer 19

DISCUSSION OF TRANSFERENCE IN THE LATTER

Question 20

Primary intervention in highly expressive psychotherapy:

Answer 20

INTERPRETATION

Question 21

Psychiatrist tells pt “You told me your feelings are hurt when spouse doesn’t pay attention to you. I think you may also be saying I hurt your feelings during last session when I didn’t let you finish before ending session.” What interview technique is this?

Answer 21

INTERPRETATION

Question 22

38 y/o pt in dynamic psychotherapy for depression says she is lesbian and is dissatisfied with her otherwise good relationship with her partner of 7 yrs b/c she wants a child and her partner does not. She thinks about leaving the relationship but this makes her feel sadness and a sense of loss. What is best intervention?

Answer 22

SUGGEST THAT CONJOINT THERAPY WITH THE PATIENT AND HER PARTNER MIGHT BE A PRODUCTIVE WAY TO EXPLORE THIS COMPLICATED ISSUE

Question 23

32 y/o F, divorced 3 times, sees a male psychiatrist, saying she needs therapy because she is paralyzed about choosing a career. Pt has started and stopped college twice, held several waitress and clerk jobs. She hoped the therapist could tell her what job to pursue. In the initial interview she asks the therapist to send bills directly to her father, who manages her money because she has difficulty managing bills and credit cards. She explained she has to live at home to save money, but hates this because she frequently fights bitterly w her father who always wants to control her. Transference issue that therapist should expect to be central theme in therapy is:

Answer 23

TRY TO GET ADVICE BUT THEN BE ANGRY AT THE THERAPIST FOR GIVING IT

Question 24

Deficit model of psychological illness in psychodynamic psychotherapy define psychopathology as:

Answer 24

WEAKENED OR ABSENT PSYCHIC STRUCTURES

Question 25

In psychodynamic tx, interpretation of transference & resistance until insight fully integrated is called:

Answer 25

WORKING THROUGH

Question 26

33 y/o pt in long term psychodynamic psychotherapy for several months is chronically late for sessions. Therapist suggests that this may be resistance. The pt says “oh, don’t take it personally, I am this way with everyone”. This response can be best understood as:

Answer 26

AN UNINTENDED CONFIRMATION OF THE PROBABLE CORE SIGNIFICANCE OF THIS BEHAVIOR.

Question 27

Studies show that short-term psychodynamic psychodynamic (STPP) psychotherapy is superior to supportive therapy in the treatment of complicated grief for certain pts. Which of the following pt characteristics predicts a better response to STPP than supportive therapy?

Answer 27

MATURE OBJECT RELATIONS

Question 28

Young female in psychodynamic psychotx admitted to seeing the resident downtown last weekend, followed him around, thinking she could later shop at the same stores and eat at same places as her greatly admired therapist. Pt not dangerous, convincingly apologized, stated that she would never repeat this behavior and hoped therapist would not “fire” her. Next step therapist should take?

Answer 28

INTERPRET PATIENT’S LONGING TO IDENTIFY WITH THE THERAPIST.

Question 29

Pt in psychodynamic psychotherapy repeatedly asks the therapist personal questions. The therapist consistently explores the reasons for the patient’s asking, and sometimes these explorations are fruitful. Regardless, the pt persists in pressing for “real answers”. The therapist response at this point is what?

Answer 29

I KNOW THIS CAN SEEM VERY FRUSTRATING, BUT THE FOCUS OF THE THERAPY SHOULD BE ON YOU.

Question 30

In context of psychodynamic psychotx, “frame” refers to what aspect of therapy?

Answer 30

HOW IT IS ORGANIZED IN TERMS OF BOUNDARIES AND CONSISTENT DEFINING RULES.

Question 31

60 y/o successful businessman has started psychodynamic psychotherapy with a young male therapist in one early session, the pt begins by saying, “before we get started, I want to let you know about a potentially lucrative investment opportunity.” This statement is best represents:

Answer 31

AN ATTEMPT BY PT, PROBABLY UNCONSCIOUSLY, TO SEDUCE AND TEST THERAPIST.

Question 32

I understand why that felt is an example of which type of psychodynamic psychotherapy intervention?

Answer 32

EMPATHIC VALIDATION

Question 33

Developmental stage in psychodynamic group therapy characterized by intimacy:

Answer 33

WORKING GROUP

Question 34

When a patient tells the clinical “I feel so lucky to have found such a wise and loving doctor” how should the physician respond

Answer 34

UTILIZE THE TRANSFERENCE TO STRENGTHEN THE THERAPEUTIC ALLIANCE

Question 35

The following diagnostic assessment is administered with a clinical interview rather than self report

Answer 35

BRIEF PSYCHIATRIC RATING SCALE

Question 36

32 y/o F w mixed anxiety/depression working well in supportive-expressive psychotherapy once weekly for past 3 months. Focus on issues related to childhood neglect/abuse she experienced, how these impact current relationships. In one session, silent/tearful. With encouragement from therapist, reports her 18-month- old daughter hospitalized w meningitis; she is upset, worried. Therapist listens silently. Pt leaves session early, misses next session. Following time, she is angry, accuses therapist of being uncaring/insensitive for not expressing concern about her child/empathizing w her distress. Therapist’s immediate response should be? (2x)

Answer 36

APOLOGIZE AND ACKNOWLEDGE THAT THE SILENCE HAD FELT HURTFUL TO THE PATIENT

Question 37

Which best defines goals of supportive psychotherapy? (2x)

Answer 37

STABILIZE PT’S FUNCTIONING, STRENGTHEN PT DEFENSES

Question 38

Patient cursed at daughter, therapist feels angry, next step

Answer 38

EXPRESS APPRECIATION, LOOK TO UNDERSTAND ACTION, LOOK FOR OPPORTUNITIES

Question 39

Role of therapist in motivational interviewing

Answer 39

POINTS OUT DISCREPANCY BETWEEN BEHAVIORAL AND PERSONAL GOALS TO MOTIVATE CHANGE

Question 40

What would best help a child facilitate the mourning process when a loved one dies?

Answer 40

A CHANGE TO EXPRESS FEELINGS OR LOSS

Question 41

Pt with addiction and social anxiety talks about painful anxiety experience at AA. Statement consistent with 12 step therapy?

Answer 41

YOU DID THE MOST IMPORTANT THING, YOU WENT TO THE MEETING. IT WILL GET EASIER

Question 42

New pt says “ you’re going to be just like the others - no doctors listen.” Best response?

Answer 42

I’M SORRY YOU FELT UNHEARD IN THE PAST. CAN YOU DESCRIBE YOUR EXPERIENCE?

Question 43

Several months of weekly individual psychotx-woman w MDD, panic d/o describes repressed memories of sexual abuse by stepfather. Therapist neutral, explores pt’s experience. Pt reports increasing conviction despite sister insisting it was impossible. Plans tp get lawyer if parents do not admit & apologize. Which is best approach?

Answer 43

DOCUMENT CAREFULLY THE UNFOLDING PROCESS AND OBTAIN SUPERVISION

Question 44

50 y/o M hospitalized for depression and melancholia. First few therapy session should focus on:

Answer 44

EDUCATE PATIENT ON NATURE OF ILLNESS AND TREATMENT

Question 45

Which best defines goals of supportive psychotherapy?

Answer 45

IMPROVEMENT OF REALITY TESTING AND REESTABLISHMENT OF THE USUAL LEVEL OF FUNCTIONING

Question 46

After mild MI 70 y/o seen by psychiatrist for depression. Seen for psychotherapy, given SSRI. Describes fear of imminent death. Psychiatrist tells him cardiologist is excellent, he is receiving best care. What illustrates supportive therapy:

Answer 46

REASSURANCE

Question 47

Supportive therapy differs from psychoanalytic therapy in that the therapist who is conducting supportive therapy does what?

Answer 47

REINFORCES EGO DEFENSES

Question 48

On the expressive-support spectrum of therapeutic interventions, which is considered the most supportive therapy intervention:

Answer 48

ADVISING

Question 49

An important technique in supportive therapy is

Answer 49

WORKING PRIMARILY IN THE PRESENT

Question 50

Elderly patient begins to ask about sex, becomes hesitant. Appropriate response?

Answer 50

YOU’RE DOING FINE, GO ON.

Question 51

Form of psychotherapy that would describe therapeutic goal as “improving ego functioning and self-esteem

Answer 51

SUPPORTIVE PSYCHOTHERAPY

Question 52

Patient in treatment wants to use phone app to manage bipolar disorder. Most appropriate response?

Answer 52

I WOULD LIKE TO REVIEW THE APP MYSELF. THEN WE CAN FURTHER DISCUSS THE IDEA.

Question 53

Patient presents with paranoia in the ED, he is hypervigilant and pacing, what technique would be most important to establish rapport?

Answer 53

ACKNOWLEDGE THE PATIENT’S FEAR

Question 54

An example of “change talk” elicited in motivational interviewing

Answer 54

IF I DIDN’T SMOKE, I COULD USE THE MONEY FOR MUSIC