PsychoDyn/Supporitve Flashcards
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)
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
A highly motivated patient in psychodynamic psychotherapy finds that he has nothing to say, which is an example of: (2x)
RESISTANCE
This treatment goal is most specific to psychoanalytic psychotherapy: (x2)
BRINGING UNCONSCIOUS CONFLICT INTO AWARENESS
College student with good grades needs repeated reassurance. What core belief might the student have?
I CANNOT BE TRUSTED TO MAKE A GOOD DECISION
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?
TURNING AGAINST THE SELF AS A DEFENSE AGAINST INTOLERABLE ANGER.
What best describes current psychoanalytic thinking about the source of countertransference phenomena in the therapist
THE THERAPISTS TOTAL EMOTIONAL REACTION TO THE PATIENT
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:
EXPLORE THE PROCESS DURING THE SESSION THAT MIGHT BE INTERFERING WITH THE ESTABLISHMENT OF THE THERAPEUTIC ALLIANCE
Which psychotherapy uses transference interpretations and clarification to develop insight and resolve conflict?
PSYCHODYNAMIC PSYCHOTHERAPY
In the context of the psychodynamic psychotherapy, the term “frame” refers to which of the following aspects of therapy?
HOW IT IS ORGANIZED IN TERMS OF BOUNDARIES AND CONSISTENT DEFINING RULES
Intensive, short-term dynamic psychotherapy is contraindicated for what condition?
ACUTE EXACERBATION OF CHRONIC SCHIZOPHRENIA
Use of meds with psychodynamic psychotherapy optimal when:
MEANINGS AND EFFECTS OF MEDS INTEGRATED INTO PT’S UNDERSTANDING
In split treatment, the role of the prescribing psychiatrist is?
EVALUATE THE PTS NEEDS FOR MEDICATIONS WHILE MAINTAINING REGULAR CONTACT WITH THE THERAPIST
Psychotherapy research shows which of the following practices in a therapeutic relationship is most supportive for improving outcomes?
COLLECTING FEEDBACK FROM THE PT ABOUT THE TREATMENT
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?
DISCREPANCY
When practicing Davanloo’s short-term dynamic psychotx, one must consistently
CLARIFY AND RELENTLESSLY CONFRONT THE PT’S DEFENSES
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:
A PRACTICAL/SUPPORTIVE APPROACH
Which of the following characteristics is common to all brief dynamic psychotherapies?
PRACTICAL WORKING THROUGH OF CONFLICT BY TRANSFERENCE INTERPRETATION
Determines if pt has ego strength for therapy
ASSESSMENT OF QUALITY OF RELATIONSHIPS
Goals of brief psychodynamic psychotherapy compared to long-term psychodynamic psychotherapy differ how
DISCUSSION OF TRANSFERENCE IN THE LATTER
Primary intervention in highly expressive psychotherapy:
INTERPRETATION
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?
INTERPRETATION
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?
SUGGEST THAT CONJOINT THERAPY WITH THE PATIENT AND HER PARTNER MIGHT BE A PRODUCTIVE WAY TO EXPLORE THIS COMPLICATED ISSUE
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:
TRY TO GET ADVICE BUT THEN BE ANGRY AT THE THERAPIST FOR GIVING IT
Deficit model of psychological illness in psychodynamic psychotherapy define psychopathology as:
WEAKENED OR ABSENT PSYCHIC STRUCTURES
In psychodynamic tx, interpretation of transference & resistance until insight fully integrated is called:
WORKING THROUGH
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:
AN UNINTENDED CONFIRMATION OF THE PROBABLE CORE SIGNIFICANCE OF THIS BEHAVIOR.
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?
MATURE OBJECT RELATIONS
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?
INTERPRET PATIENT’S LONGING TO IDENTIFY WITH THE THERAPIST.
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?
I KNOW THIS CAN SEEM VERY FRUSTRATING, BUT THE FOCUS OF THE THERAPY SHOULD BE ON YOU.
In context of psychodynamic psychotx, “frame” refers to what aspect of therapy?
HOW IT IS ORGANIZED IN TERMS OF BOUNDARIES AND CONSISTENT DEFINING RULES.
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:
AN ATTEMPT BY PT, PROBABLY UNCONSCIOUSLY, TO SEDUCE AND TEST THERAPIST.
I understand why that felt is an example of which type of psychodynamic psychotherapy intervention?
EMPATHIC VALIDATION
Developmental stage in psychodynamic group therapy characterized by intimacy:
WORKING GROUP
When a patient tells the clinical “I feel so lucky to have found such a wise and loving doctor” how should the physician respond
UTILIZE THE TRANSFERENCE TO STRENGTHEN THE THERAPEUTIC ALLIANCE
The following diagnostic assessment is administered with a clinical interview rather than self report
BRIEF PSYCHIATRIC RATING SCALE
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)
APOLOGIZE AND ACKNOWLEDGE THAT THE SILENCE HAD FELT HURTFUL TO THE PATIENT
Which best defines goals of supportive psychotherapy? (2x)
STABILIZE PT’S FUNCTIONING, STRENGTHEN PT DEFENSES
Patient cursed at daughter, therapist feels angry, next step
EXPRESS APPRECIATION, LOOK TO UNDERSTAND ACTION, LOOK FOR OPPORTUNITIES
Role of therapist in motivational interviewing
POINTS OUT DISCREPANCY BETWEEN BEHAVIORAL AND PERSONAL GOALS TO MOTIVATE CHANGE
What would best help a child facilitate the mourning process when a loved one dies?
A CHANGE TO EXPRESS FEELINGS OR LOSS
Pt with addiction and social anxiety talks about painful anxiety experience at AA. Statement consistent with 12 step therapy?
YOU DID THE MOST IMPORTANT THING, YOU WENT TO THE MEETING. IT WILL GET EASIER
New pt says “ you’re going to be just like the others - no doctors listen.” Best response?
I’M SORRY YOU FELT UNHEARD IN THE PAST. CAN YOU DESCRIBE YOUR EXPERIENCE?
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?
DOCUMENT CAREFULLY THE UNFOLDING PROCESS AND OBTAIN SUPERVISION
50 y/o M hospitalized for depression and melancholia. First few therapy session should focus on:
EDUCATE PATIENT ON NATURE OF ILLNESS AND TREATMENT
Which best defines goals of supportive psychotherapy?
IMPROVEMENT OF REALITY TESTING AND REESTABLISHMENT OF THE USUAL LEVEL OF FUNCTIONING
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:
REASSURANCE
Supportive therapy differs from psychoanalytic therapy in that the therapist who is conducting supportive therapy does what?
REINFORCES EGO DEFENSES
On the expressive-support spectrum of therapeutic interventions, which is considered the most supportive therapy intervention:
ADVISING
An important technique in supportive therapy is
WORKING PRIMARILY IN THE PRESENT
Elderly patient begins to ask about sex, becomes hesitant. Appropriate response?
YOU’RE DOING FINE, GO ON.
Form of psychotherapy that would describe therapeutic goal as “improving ego functioning and self-esteem
SUPPORTIVE PSYCHOTHERAPY
Patient in treatment wants to use phone app to manage bipolar disorder. Most appropriate response?
I WOULD LIKE TO REVIEW THE APP MYSELF. THEN WE CAN FURTHER DISCUSS THE IDEA.
Patient presents with paranoia in the ED, he is hypervigilant and pacing, what technique would be most important to establish rapport?
ACKNOWLEDGE THE PATIENT’S FEAR
An example of “change talk” elicited in motivational interviewing
IF I DIDN’T SMOKE, I COULD USE THE MONEY FOR MUSIC
