therapeutic modalities Flashcards
Most likely to be enhanced by the strategies of putting the pt at ease, finding the pt’s pain and expressing compassion, evaluation pt’s insight, and showing expertise: (5x)
RAPPORT
The factor most consistently associated with therapy outcome in psychotherapy research: (3x)
STRENGTH OF THERAPEUTIC ALLIANCE
A set of feelings that a patient reenacts in the therapeutic relationship are called: (x2)
TRANSFERENCE
Business executive hospitalized for bleeding ulcer repeatedly argues with a well-liked head nurse and threatens to leave AMA. Best action for C&L psychiatrist is: (2x)
LISTEN TO PT’S COMPLAINTS ACKNOWLEDGE HIS DISCOMFORT WITH THE PASSIVE POSITION THAT HE IS UNACCUSTOMED TO
Common theme in psychotherapy in the elderly: (2x)
LOSS
As opposed to long-term psychotherapy, time-limited therapy more likely to: (2x)
SELECT CENTRAL ISSUE AS FOCUS
For the treatment of pts with compulsive sexual behavior, the best results have been seen with which of the following approaches? (2x)
TWELVE STEP GROUPS
Two most powerful predictors of outcome in any form of psychotherapy are: (2x)
EMPATHY AND THERAPEUTIC ALLIANCE
The best response to a pt who reports a fixed false belief that his neighbor is poisoning his dog and sitting all day at the window monitoring is: (2x)
EMPATHIZE WITH THE PT, BUT AVOID DIRECT CONFRONTATION ABOUT THE DELUSION
Psychotherapy where pts realistically evaluate their interactions w others & therapist offers direct advice/helps pts make decisions/ignores transference issues. (2x)
INTERPERSONAL PSYCHOTHERAPY (IPT)
Most likely represents an acceptable boundary crossing by a therapist as opposed to a boundary violation: (2x)
RECEIVING COOKIES AS AN EXPRESSION OF GRATITUDE BY A PT NEAR TERMINATION.
Therapeutic empathy is best described as the therapist’s ability to: (2x)
GRASP PT’S INNER EXPERIENCE FROM PT’S PERSPECTIVE
Motivational interviewing often used as part of the treatment of which conditions? (2x)
SUBSTANCE ABUSE
Therapeutic technique where therapist instructs the patient to hold onto a symptom: (2x)
PARADOXICAL INTERVENTION
Without evident distress, pt calmly reports to the psychiatrist, “Since I was last here, my significant other dumped me.” The doctor responds by pointing out the discrepancy between the pt’s affect and the content described. This response is an example of: (2x)
CONFRONTATION
Psych resident dislikes alcoholic pts and avoids working with them. In discussing the problem, says that pts are hopeless and unmotivated and she can’t empathize with them. Example of? (2x)
COUNTERTRANSFERENCE
Catharsis is: (2x)
VERBAL EXPRESSION OF SURPRESSED TRAUMATIC EXPERIENCES AND FEELINGS
barrier to widespread use of telepsychiatry
PHYSICIAN DISSATISFACTION
Example of behavioral analysis strategy
AT WHAT POINT DURING THE DAY DID YOU FIRST NOTICE YOU WERE THINKING ABOUT CUTTING
Pt BIB police to ED with disorganized behavior. Pt askes are you a real psychiatrist?” Best response?
Recent meta- analyses have suggested what with regard to the use of psychotherapy to treat depression?
OTHER PSYCHOTHERAPIES HAVE EFFICACY COMPARABLE TO CBT
Psychiatrist’s mind wanders during sessions, what should the psychiatrist do?
EXAMINE INNER THOUGHTS AND FEELINGS
What theory is the basis of mentalization-based therapy?
BOWLBY’S ATTACHMENT THEORY
During initial psych interview, pt tearfully discusses painful ending of romantic relationship. What should Dr. say to establish therapeutic alliance?
IT SOUNDS LIKE THIS HAS BEEN VERY DIFFICULT FOR YOU.
Psychiatrist behavior of raising eyebrows, leaning towards pt, saying “Uh-huh”
FACILITATION
Redirecting discussion by talking about irrelevant stuff
RESISTANCE
During a clinical interview, the physician recapitulates what the pt has said so far and says to pt “I just want to make sure that I’ve got everything right up to this point”. This is an example of:
SUMMATION
When psychiatrist asks about mania, pt responds, “that sounds exactly like my cousin,” and proceeds to tell long story about cousin but doesn’t answer the psychiatrist’s request. This is an example of:
TANGENTIALITY
In initial psych interview, pt frustrated that his last psychiatrist had brief visits & “just gave me another pill every time.” Interviewing psychiatrist responds “so you would like your psychiatrist to listen & understand you before adjusting your meds.”
CLARIFICATION
Pt who had difficult childhood calls therapist mother’s name and quickly corrects error. What is this an example of?
PARAPRAXIS
Pt w/ BMD who has been making progress in long-term psychodynamic psychotherapy enters session obviously distraught. After listening to scattered seemingly unimportant details of recent daily life, therapist asks if pt is avoiding something too uncomfortable to talk about. Pt responds w intense anger/distress. “I just heard you are getting a divorce, I am sick about it. Here I am counting on you to help me sort out my chaotic life and messed-up relationships, and you can’t even keep your own marriage together! What are you, some kind of hypocrite? I think I should leave and find someone who knows what they’re doing!” Best response for the therapist to make?
I AM GOING TO NEED A MOMENT TO THINK ABOUT WHAT YOU’VE SAID AND ARE FEELING BEFORE I CAN RESPOND.
8yr old evaluated for asthma, found to have ADHD symptoms, put on stimulant, behavioral problems continue, sent to psychiatrist and psychologist, this is an example of what level of collaborative care?
SHARED (INTEGRATED) CARE
17 y/o receiving counseling for school truancy. Student understand truancy is not a desirable behavior and is discusses ways to improve school attendance. What stage of change is student in?
PREPARATION
College student in therapy, the Dean calls therapist requesting info about the student’s therapy due to recent reports from a dorm supervisor. Therapist should:
REFUSE THE DEAN’S REQUEST FOR INFORMATION
An important counter-transference issue in an interethnic psychotherapeutic relationship is:
DENIAL OF DIFFERENCES
Abstinence compliance increases with random UDS. This is ex of:
PARTIAL REINFORCEMENT
A new pt asks therapist, “are you Christian?” What is best response?
ARE YOU CONCERNED THAT IF WE ARE NOT OF THE SAME RELIGION, I WON’T BE ABLE TO TREAT YOU PROPERLY?’
Exchange during initial interview after pt’s former therapist closed his practice: pt expresses concern about new therapist being too young/inexperienced, states she doubts new therapist can provide any new insights. Best response to further goal of getting to know pt, establish whether therapy w new therapist would be appropriate IT CAN BE VERY HARD TO START OVER WITH A NEW THERAPIST. HOW HAVE YOU BEEN FEELING ABOUT HAVING TO END YOUR TREATMENT WITH DR. BROWN?”
A patient repeatedly becomes distressed after what seems, even to the pt, to be minor disappointments. The patient also seems to suffer from extreme narcissistic vulnerability. A therapist utilizing self-psychology would be most likely to interpret this due to which of the following factors?
A LACK OF DEVELOPMENTALLY APPROPRIATE EMPATHY FROM CAREGIVERS
Treating a much older pt who asks about therapist’s age. Best response:
MAYBE YOU’RE CONCERNED ABOUT WHETHER I AM EXPERIENCED ENOUGH TO TREAT YOU?
Pt seeing new psychotherapist weekly x3 wks hesitantly complained about being able to overhear much of what pt in the preceding session was saying. Pt assured therapist that he had tried not to listen and had left the waiting room to wait outside until the other pt had left. Which is best response?
APOLOGIZE FOR THE LACK OF PRIVACY AND INDICATE THAT FURTHER MEASURES, SUCH AS MUSIC SYSTEM IN THE WAITING ROOM, WILL BE UTILIZED
MD sees psychiatrist w increasing sense of dislike for a blaming, externalizing pt who pits family members against the MD. What should psychiatrist discuss w MD?
COUNTERTRANSFERENCE
A pt with h/o lifelong depression & failed relationships complains (very angry) (after several weeks of therapy) that she is expected to trust the Dr. without even knowing anything about him (credentials or personally) what should the Dr say?
EMPATHIZE WITH THE PT’S FEARS OF TRUST AND FEELING OF BEING AT A DISADVANTAGE
Psychotherapy technique for children with Tourette’s syndrome.
HABIT REVERSAL
62 y/o with lung cancer, weight loss, fatigue, and persistent cough. Pat refuses to accept Dx of cancer and states will “get over this infection.” Pt refuses all further testing and asks for antibiotics to “recover in peace.” C&L psychiatrist’s role is:
EVALUATE PT’S COPING STYLE AND HELP THE MEDICAL TEAM SEE THE PT’S RESPONSES IN THE CONTEXT OF HER UNIQUE PERSONALITY AND LIFE CIRCUMSTANCES
Young female starting cognitive therapy with a female resident asks for a hug. Resident should first:
EXPLAIN WHY PHYSICAL CONTACT IS AVOIDED
C&L psychiatrist uses all therapeutic approaches except:
EXPLORATORY PSYCHODYNAMIC
Psychiatrist is treating an older pt who is a successful executive. Pt feels grateful for the help w/ his depression and offers some tips on investing to the psychiatrist. What is the most appropriate action at this point from the psychiatrist?
EXPLORE PT’S MEANINGS AND FEELINGS ABOUT THE OFFER
Female psych resident says pt saw resident in town over weekend. Followed her around. Thought she could later shop at same stores and eat at same restaurants as her greatly admired therapist. Nothing wrong in pt’s bx or material suggesting she is dangerous. Pt apologizes convincingly, says will not do again. Hopes therapist will not fire her. What is next best step?
INTERPRET PT’S LONGING TO IDENTIFY W THE PSYCHIATRIST
What if pt asks whether you’re still in training during intake interview?
INFORM THE LEVEL OF TRAINING
Midway through psychotherapy session, a psychiatrist’s mind wanders despite repeated refocus. Best immediate action:
EXAMINE OWN INNER FEELINGS ABOUT THE PATIENT
Pt sees therapist and makes threats and becomes agitated. Therapist feels uneasy, the next step is to:
INTERRUPT INTERVIEW TO GET HELP
Young pt in therapy returns to school, announces to therapist that he can pass classes, will graduate. Best response:
OFFERING CONGRATULATIONS
Beginning therapist feels great empathy for depressed pt fails to maintain sufficient distance to observe self-destructive patterns. To avoid this pay attention to:
OVERIDENTIFICATION WITH PATIENT
Social skills training for those with persistent mental illness is an essential part of:
PSYCHIATRIC REHABILITATION
Therapist is working w family of schizophrenic. Strategies include informing about illness, social support, management guidelines. Therapist encourages calm problem solving approach/facilitates stress and stigma reduction when possible. Which model is therapist using?
PSYCHOEDUCATIONAL
Biofeedback usually helps pts with which medical syndrome?
RAYNAUD’S SYNDROME
What interventions are consistent w the theoretical assumptions of crisis Tx?
REASSURANCE, BRIEF HOSPITALIZATION, PSYCHODYNAMIC INSIGHT, TREATMENT WITH PSYCHOTROPIC MEDICATIONS (NOT FOCUSING ON PAST RELATIONSHIPS)
During last session of successful psychodynamic psychotherapy, pt warmly expresses gratitude for everything, saying that the help the therapist has given has made a big difference. Appropriate response?
RESPOND BY SAYING YOU TOO HAVE ENJOYED THE WORK
What is an example of a boundary violation?
INVESTING IN A PT’S BUSINESS
After attending several sessions of individual psychotherapy for anxiety and depression, 24 y/o M revealed his homosexuality to his heterosexual male psychiatrist. Therapist realizes he is uncomfortable when pt expresses longings for a male. Therapist also tends to overemphasize any material that might represent pt’s heterosexual wishes. The next best step for the psychiatrist would be to:
SEEK CONSULTATION TO DISCUSS COUNTERTRANSFERENCE ISSUES
Pt w/ mild MR in program designed to develop new behaviors by modeling/reinforcement, then practice them.
SOCIAL SKILLS TRAINING
Therapist preoccupied w/ patient. Acknowledges this but unable to shake feeling
TALK TO SUPERVISOR
15 y/o male bib parents, does not want to speak with psych
THANK HIM FOR COMING IN AND ASK HIM IF HE’D LIKE TO BE SEEN ALONE OR WITH HIS PARENTS
What was most important factor in determining tx outcomes in National Institute of Mental Health Treatment of Depression Collaborative Research Program (1996)?
THERAPEUTIC ALLIANCE
While assessing for DV, examiner says to pt/spouse, “The tension that builds up between you must be incredibly stressful. It’s not unusual that people who are stressed out can have trouble controlling themselves or can do things they didn’t intend, like screaming at or even hitting their partner. Has anything like that happened to you?” Which technique is this?
NORMALIZATION
Pt repeatedly redirecting discussion by talking about irrelevant topics is example of:
RESISTANCE
Core principle of motivational interviewing that is used to treat addictive behaviors:
DEVELOP DISCREPANCY
Individual psychotherapy for alcoholics most effective when it focuses on:
INTERACTIONS WITH PEOPLE
Programmed practice, or exposure therapy, is an indicated treatment for what disorder?
AGORAPHOBIA
Pt with multiple social fears is terrified of public speaking. As the next step in treatment, the therapist arranges for the pt to give 15 minutes talk to clinical staff. This is an example of:
FLOODING
Exposure and flooding together with response prevention are techniques of behavioral therapy aimed at which of the following?
HASTENING THE EXTINCTION OF A CONDITIONED FEAR OR ANXIETY RESPONSE
Elements common to both CBT and eye movement desensitization and reprocessing in the treatment of patients with PTSD include:
CONTROLLED EXPOSURE TO TRAUMA RELATED TRIGGERS
Pt w fear of heights. Pt instructed to visualize crossing a bridge. What is the therapeutic technique?
IMAGINAL EXPOSURE
Meta-analysis suggests which of the following for psychotherapy to treat depression?
OTHER PSYCHOTHERAPIES HAVE EFFICACY COMPARABLE TO CBT
During an initial office evaluation, the pt tells the psychiatrist, “my spouse told me I had to be evaluated.” Which of the following would be the most empathic response?
HOW DO YOU FEEL ABOUT THAT?
The concept of the identified patient in therapy refers to:
ONE FAMILY MEMBER WHO HAS BEEN LABELED THE PROBLEM BY THE FAMILY
Psychosocial therapy that has shown efficacy in some studies in improver cancer survival rates:
GROUP THERAPY WITH OTHER CANCER PATIENTS
Comprehensively researched therapy for mood d/o’s
INTERPERSONAL PSYCHOTHERAPY
Therapeutic focus on the on pt’s current social functioning is most characteristic of:
INTERPERSONAL PSYCHOTHERAPY
26 y/o pt with depressed mood and dissatisfaction with life, feeling isolated and having few friends who is not under undue stress and historically copes well with personal problems would benefit from what type of psychotherapy?
INTERPERSONAL THERAPY
Which psychotherapy would therapist be inclined to gratify pts’ dependency needs?
SUPPORTIVE
Pt enters psychotherapy because of problems in his relationship with his wife. During the sessions, pt talks about his family of origin, his boss, and his problems at work, but never discusses details about his wife. This is an example of which of the following?
RESISTANCE
Principle of confrontation:
I THINK YOU’D RATHER TALK ABOUT YOUR JOB THAN FACE THE SADNESS YOU FELT IN OUR LAST SESSION
Example of empathic comment
YOU MUST FEEL TERRIBLE RIGHT NOW.
Recovering addict in relapse prevention therapy, and has many risk factors. Rather than developing a coping strategy for each risk factor, do what?
FOCUS ON SKILL TRAINING, COGNITIVE REFRAMING, AND LIFESTYLE INTERVENTIONS
In psychotherapy a pt states that he still feels devalued by criticism of father. Therapist comment: It must hurt when you are treated that way. This is example of:
EMPATHIC VALIDATION
Therapy technique of prescribing a pre-existing sx behavior in relationship therapy
PARADOXICAL INTENT
The doctor and patient relationship is described as fiduciary relation is:
BASED ON TRUST
When you mentioned your sibling’s problem, your voice cracked and, for a moment, I thought I heard anger in your voice. Which interviewing technique does psychiatrist use here?
FACILITATION, REFLECTION
The purpose of reflective statements during patient interview is for
IS TO ENSURE WHAT THE PATIENT SAID IS UNDERSTOOD
What characteristic is associated with better adaptation in individuals >65?
UNCRITICAL ACCEPTANCE OF IDEAS
Which Tx modalities provides care for seriously mental ill pts in community via a multidisciplinary Tx team:
ASSERTIVE COMMUNITY TREATMENT
Which controlling for health status, which of the following best describes the relationship between retirement and subsequent mortality risk?
NO INCREASE IN MORTALITY RISK
Pt in long term psychodynamic psychotherapy attacks therapist for being controlling and uncaring. This is an example of what?
TRANSFERENCE
