Treatment Interventions

Question 1

A psychologist is working with an American Indian client who has suffered symptoms of depression since the death of her grandfather. In terms of religious and spiritual values in this case, what should the psychologist do?

A. incorporate a traditional healer in the treatment process
B. explore and reinforce the therapeutic alliance of religious and spiritual events for the clients
C. avoid addressing or incorporating these factors until after the client has had complete medical and medication evaluations
D. avoid stereotyping and allow the client to take the lead in discussing the role of these values, if they are significant for her.

Answer 1

Explore and reinforce the therapeutic alliance of religious and spiritual events for the clients

NOTE:

• Before determining the best way to proceed, the psychologist MUST ascertain the meaning of religion or spirituality for this particular client
• For religious or spiritually-oriented American Indians, natural forces are associated with the life process itself, which influences their actions in a significant way
• The psychologist should NOT place the burden or raising these issues (or any other issue that might be relevant to the assessment) on the client.
• Research has found that, for American Indians, one consequence of their history in the US is that the clt may be distrustful or a psychotherapist’s efforts to provide counseling in a “value-free” environment
• They prefer a therapist who actively helps them to reaffirm the values of their own culture

Question 2

Your new therapy client tells you that he has started having trouble with his boss at work and asks what you think he should do about it. As the practitioner of client-centered therapy, you would do which of the following?

A. lead the client by asking probing questions
B. get the client to ask him to think in terms of the “here and now”
C. find some connection between the client’s present behavior and past experience
D. let the client arrive at his own decisions and thoughts

Answer 2

Let the client arrive at his own decisions and thoughts

ROGERIAN THERAPY:

• Clients are viewed as the expert of his/her own inner processses and encourages the client to come to his/her own decisions and insights
• Rogerian therapy is a non-directive which de-emphasizes advice-giving, persuasion, diagnosis, and interpretation, and allows for client self-discovery and problem resolution

Question 3

Which medication requires the regular monitoring of a patient’s blood?

A. Clozaril
B. Chlorpromazine
C. Clonazepam
D. Celexa

Answer 3

Clozaril

NOTE:

• an antipsychotic medication
• associated with adverse hematological side effects including white blood cells dyscrasia
  
  • NOTE: Blood dyscrasia is a medical term referring to pathological conditions in which certain blood constituents are abnormal or present in abnormal quanities, as occurs, for example, in hemophilia and leukemia
• requires weekly white blood cell counts for patients that the drug

Question 4

A middle-aged man comes to treatment displaying the following symptoms: slurred speech, unsteady gait and impaired attention. The psychologist smells alcohol on the client’s breath, and when she questions him about this, he admits to drinking “now and then,” but denies being intoxicated at the time of the intervew. Of the following findings about the client, which one is LEAST likely to contribute to the psychologist’s decision to refer him for inpatient detoxification (acute hospital care)?

A. he lacks support
B. several previous attempts at outpatient treatment for his alcoholism have failed
C. despite clear evidence to the contrary, he has denied being intoxicated during the interview
D. in addition to alcohol dependence, he has significant depression

Answer 4

Despite clear evidence to the contrary, he has denied being intoxicated during the interview

NOTE:
Important indicators for inpatient detox (acute hospital care) include the following:

1. client poses an imminent danger to self
2. significant psychopathology
   EX: significant depression
3. serious medical complications
4. high-risk chemical withdrawal
   EX: possible seizures or delirium tremens
5. client has developed a high tolerance to one or more substances
6. previous attempts at outpatient treatment have failed
7. client lacks social support
8. client exhibits severely impaired social, familial or occupational functioning
9. Denial of the problem, which can include denial that one is intoxicated during an interview, is common among individuals who abuse or are dependent on alcohol or other drugs

• An unwillingness to admit to the problem is likely to have an impact on the course and outcome of treatment, but it is not necessarily an indicator of the severity of the person’s addiction or a need for acute inpatient care.
• To increase the reliability of the information the client proivdes, the psychologist would want to adopt a straightforward, nonjudgmental approach so that self-disclosure will feel safer for the client; explain that disclosures and treatment records are confidential; obtain information from signfiicant other and could consider referring the client for blood or urine screening

Question 5

Which of the following is NOT a component of Panic Control Treatment (Barlow & Craske, 2000)?

A. cognitive restructuring
B. breathing retraining
C. interoceptive exposure
D. stress innoculation training

Answer 5

Stress innoculation training

PANIC CONTROL TREATMENT (PCT):
incorporates 4 components:

1. psychoeducation is used to provide the client with information about Panic disorder
2. cognitive restructuring helps the client identify, challenge and replace maladaptive thoughts
3. breathing retraining exercises are used to eliminate hyperventilation
4. interoceptive conditioning reduces the clients fear of the bodily sensations associated with anxiety

NOTE:

• Stress innoculation training (SIT) is a comprehensive cognitive-behavioral approach to teaching clients how to cope with stress
• Althogh SIT and PCt share some specific strategies, SIT is not one of the components of PCT

Question 6

The goals and objectives of treatment are derived from the case formulation and represent the desired outcomes of psychotherapy. Which of the following is NOT true about treatment goals and objectives?

A. they must be achievable wthin a reasonable time period, given the client’s characteristics, circumstances, and resources
B. the psychologist and the client must agree about them
C. they must be stated in terms that the client understands
D. objectives, but not necessarily goals, should be stated in concrete, quantifiable terms

Answer 6

The psychologist and the client must agree about them

Question 7

Your new client, Kendall K., age 27, developed symptoms that meet the diagnostic criteria for PTSD several months after being mugged at gunpoint. Based on your knowedge of the research on effective treatment for PTSD, you will most likely use which of the following interventions for Kendall?

A. stress innoculation training and exposure therapy
B. stress innoculation training and hypnotherapy
C. brief dynamic therapy and relaxation therapy
D. supportive counseling and exposure therapy

Answer 7

Stress innoculation training and exposure therapy

NOTE:

• Research has generally found that stress innoculation (anxiety management), exposure therapy, cognitive therapy, and psychoeducation to be the most useful treatments for PTSD

Question 8

A therapist who is using stress innoculation training to help a client deal with job-related stress will first:

A. help the client understand her behavioral and cognitive responses to stressful situations
B. have the client self-monitor her behavior to identify the specific antecedents of stress
C. have the client develop a stress (anxiety) hierarchy
D. use biofeedback to help the client identify and alleviate her physiological reactions to stress

Answer 8

Help the client understand her behavioral and cognitive responses to stressful situations

STRESS INNOCULATION:
CBT technique that consists of (3) phases:

1. education (helping the client understand his/her behavioral and cognitive responses to stressful situations)
2. skill acquisition (helping the client acquire and rehearse a variety of coping skills)
3. application (having the client apply the coping skills to imagined, filmed, and in-vivo stress producing situations)

Question 9

Dr. Swift, a Euro-American therapist, notices that many of her low-income therapy clients are late for their appointments. Being familiar with the impact of class values on the therapeutic process, she interprets this as a manifestation of which of the following?

A. indifference or hostility
B. resistance
C. a weak client-therapist alliance
D. a different orientation towards time

Answer 9

A different orientation towards time

NOTE:

• Due to their life experiences (e.g., waiting for extended periods at medical clinics and government agencies), low-income clients often place less emphasis on punctuality than do other clients

Question 10

During your first therapy session with a Chinese-American family that adheres to traditional Asian values, it is MOST important for you to:

A. clarify your theoretical orientation and the purpose and goals of therapy within the context of that orientation
B. establish your credibility by showing familiarity with the family’s cultural background and offering possible explanations for and solutions to the family’s difficulties
C. assess the problem from the perspective of each individual family member and encourage family members to express their feelings freely and openly.
D. identify members of the extended family and community who might act as a source of support for the family

Answer 10

Establish your credibility by showing familiarity with the family’s cultural background and offering possible explanations for and solutions to the family’s difficulties

NOTE:

• An important initial task for therapists when working with Asian clients —especially those who adhere to traditional values –is to establish credibility.
  
  • This can be achieved in several ways including: displaying diplomas and certificates in the office
• demonstrating familiarity with the client’s cultural background
• offering a possible explanation for the client’s problem
• providing some immediate solutions to that presenting problem

Question 11

Treatment for Body Dysmorphic Disorder is most likely to be effective when it includes which of the following?

A. cognitive restructuring and anxiety management training
B. cognitive restructuring, exposure and response prevention
C. dialetical behavior therapy and contingency managment
D. interpersonal therapy and stimulus control

Answer 11

Cognitive restructuring, exposure and response prevention

NOTE:

• Current treatment for BDD often combines an SSRI with CBT, with therapy including cognitive restructuring and exposure

COGNITIVE RESTRUCTURING:

• involves identifying and replacing problematic thoughts

EXPOSURE:

• entails exposing the individual to anxiety-arousing situations while preventing him/her from making an avoidance response or engaging in usual anxiety-reducing rituals (e.g., having the individual who to a public place without hiding or camouflagint the bodily defect)

Question 12

The reattribution technique would be most useful for addressing which of the following cognitive distortions?

A. “No matter how much I study, I’ll never be able to pass this exam.”
B. “Even tthough my husband complimented me today, I know he’s planning to leave me,”
C. “If I don’t get a job offer from this company, I’m a failure”
D. “whenever there’s a conflict in my family, it’s always my fault.”

Answer 12

“Whenever there’s a conflict in my family, it’s always my fault.”

REATTRIBUTION TECHNIQUE:

• useful for clients who tend to blame themselves for negative outcomes and involves hanging the client consider other possible causes of an outcome
  
  • EX: consider the possibility that other family members contribute to family conflicts)
• NOTE:
• Reattribution: re-assigning cause or blame

Question 13

A psychologist is meeting with a Chinese-American man, age 50, and the man’s mother, age 80. A physician has recommended that the mother be placed in a nursing home. She has become disoriented and frail and her memory is very impaired. The psychologist discusses the doctor’s recommendation with the male while his mother is also in the room. The man listens politely to the psychologist for a few moments, and then says that his mother is fine and can continue living at his home. How should the psychologist interpret this situation?

A. The man is unwilling to accept the severity of his mother’s condition
B. The man is not comfortable dicussing the issue
C. The man does not understand the nature of nursing home care
D. The physician’s recommendation was premature

Answer 13

The man is not comfortable dicussing the issue

NOTE:

1. A traditional Asian person is likely to be uncomfortable discussing family issues with an “outsider” such as a psychologist, particularly issues concerning his parents or other elders
2. A traditional Asian person is likely to value interdependence and responsibility to his family (rather than interdependence and autonomy) and respect for elders (rather than egalitarian values)

Question 14

During this first therapy session, Delbert D. tells Dr. Reed that he has come to see her because his girlfriend has said she will leave him if he doesn’t do something about his “drinking problem.” Delbert admits that he sometimes drinks too much. He also says that he should probably do something about it but that he doesn’t know where to start. From the perspective of the transtheoretical (stage of change) model, Dr. Reed should adopt which of the following roles when working with Delbert?

A. experienced coach
B. consultant
C. nurturing parent
D. Socractic teacher

Answer 14

Socratic teacher

NOTE:

• Delbert is aware that drinking is a problem for him, but he has come to therapy as the result of his girlfriend’s threat and has no plans for change
• For clients in this stage, therapists are most effective if they adopt the role of a SOCRATIC TEACHER who helps the client achieve insight into his or her condition
• The role of a EXPERIENCED COACH is most effective for a client in the preparation stage. The therapist provides encouragement and understanding of the change process
• The role of a CONSULTANT is best for a client in the action stage or maintenance stage. The therapist offers encouragement and reminders of the learning in the previous stages.
• In the maintenance stage, the therapist also provides information to prevent relapse

Question 15

An assessment of Selma S. reveals that her symptoms meets the criteria for a diagnosis of major depressive disorder. During the initial sessions of therapy, her therapist –a practitioner of interpersonal therapy (IPT) —will:

A. take a psychosocial history and work with Selma to identify concrete treatment objectives
B. work with Selma to identify concrete treatment objectves and have her sign a treatment contract.
C. take an interpersonal inventory and encourage Selma to adopt the “sick role”
D. take an interpersonal inventory and have Selma keep a “daily log of dysfunctional thoughts”

Answer 15

Take an interpersonal inventory and encourage Selma to adopt the “sick role”

NOTE:
First few sessions of IPT involve accomplishing tasks:

1. building a working alliance
2. educating the client about his/her sx’s
3. taking an interpersonal inventory
4. encouraging the clt to adopt the “sick role” (which excuses the client from blame and from participating in usual performance activities)
5. choosing an area of focus for therapy

Question 16

The client, a 68-year old man who retired six months ago, reports that he has been feeling depressed, isolated, and useless. He has seen his doctor, who ruled out a medical condition. What intervention strategy should be used with this client?

A. perform a “life review”
B. alter the man’s mistaken beliefs about aging and retirement
C. help the man identify activities that will restore meaning to his life
D. address “unfinished business”

Answer 16

Help the man identify activities that will restore meaning to his life

NOTE:

• To help a client negotiate an identity transition, a therapist should empathize and help the client come to terms with his present situations and then help the client adapt to his new roles and the changes in his daily life.
• In this case, the man is complaining of feeling depressed, isolated, and useless, indicating that it would be most useful to help him develop or re-establish a sense of fulfillment or purpose in his life
• This would be best accomplished by exploring different activities that he could begin to engage in (e.g., volunteer work, hobbies)

Question 17

A functional behavioral analysis of a child’s acting out behaviors in school is likely to find that the _______ associated with the behavior is attention from peers or escape from an undesirable activity.

A. primary gain
B. secondary gain
C. discriminative stimulus
D. functional stimulus

Answer 17

Secondary gain

NOTE:

• refers to the external benefit received by engaging in a behavior
• In the context of acting-out and other problematic behaviors, this benefit often takes form attention or escape

Question 18

Group therapy might be appropriate in all of the following circumstances, EXCEPT:

A. the client’s primary problem involves difficulties with intimacy
B. the client is unmotivated to change
C. the client is psychologically sophisticated
D. the client wants to overcome her shyness

Answer 18

The client is unmotivated to change

NOTE:

• Group therapy should be considered as an appropriate format of treatment when:

1. the client is motivated to change
2. the client is verbally and psychologically sophisticated
3. the client finds peer support and feedback is beneficial
4. the client has a positive view of group therapy

Question 19

For youth in early to mid-adolescence who have recently developed symptoms of Conduct Disorder but have not exhibited the most serious types of conduct problems, the treatment-of-choice is most likely to be:

A. family therapy
B. multisystemic therapy
C. day treatment
D. methylphenidate

Answer 19

Family therapy

• considered the essential component of treatment
• family therapy or parent management training is often combined with behavior therapy and pharmacotherapy

MULTISYSTEMIC THERAPY (MST):

• used to treat individuals with Conduct Disorder but is designed for youth in mid-to adolescence who have exhibited the more serious symptoms of Conduct Disorder and may be at risk for institutionalization

DAY TREATMENT:

• useful for individuals who cannot be treated successfully as outpatients and, therefore, would not be the treatment of choice for youth who are exhibiting less severe symptoms of Conduct Disorder

Question 20

You have been seeing a woman in therapy for over a year. First she worked on her grief over losing her father and more recently she asked to shift the focus of therapy to creating a relationship and finding a better job. She comes in to session sweating and is feeling jittery and shaky. You suspect that she has been using drugs and is in withdrawal. At first she denies that she has been using and says that she is getting the flu. She then admits that she has been taking Xanax that she buys on the Internet. What treatment would you consider?

A. medical evaluation, tell her to stop using and see her in therapy
B. medical evaluation, inpatient therapy, and therapy
C. medical evaluation, psychiatric evaluation and a 12 step program
D. medical evaluation, medical withdrawal, 12-step referral, and therapy

Answer 20

Medical evaluation, medical withdrawal, 12-step referral, and therapy

NOTE:

• You would begin your treatment for the new symptom, drug withdrawal with a medical referral
• Then you would need the doctor to evaluate if medical withdrawal is going to be necessary in a hospital
  
  • Xanax is a benzodiazepine. Withdrawal from it can be fatal for some people and must be managed by a medical doctor
  • Sudden cessation of Xanax can cause users to have convulsions, which can lead to death.
    
    • More commonly you are likely to see symptoms of jitteriness, irritability, insomnia and sweating, shaking and rapid heartbeat

Question 21

When working with American Indian/Alaskan Native clients, an effective intervention would combine coordination with traditional healers (if appropriate), incorporation of memebrs of the extended family and a(n):

A. insight oriented approach
B. reality therapy or a solution focused approach
C. combination of client-centered and behavioral approaches
D. combination of Adlerian and ratinal emotive approaches

Answer 21

Combination of client-centered and behavioral approaches

Question 22

After seeing Audra for three months, she tells you that she has been hitting her child on days that she gets upset at work. She says that things are very tense at work. Audra admits that she broke her child’s arm last moonth and tell you that she is so ashamed by her behavior. Audra starts to cry and tells you that she knows that waht she is doing is wrong. You report child abuse to CPS when she leaves the office. How will you repair the relationship with this woman?

A. Explain to her in the next session that you are a mandated reporter
B. Call her on the phone and tell her that you have reported her for child abuse because you are a mandated reporter
C. Allow her to express her feelings in session and explain to her your duties as a mandated reporter
D. Call her on the phone and let her express her feelings

Answer 22

Allow her to express her feelings in session and explain to her your duties as a mandated reporter

NOTE:

• You would want to look for the answer that includes BOTH of these elements
• It is the best practice for the psychologist to diffuse any angry or hurt feelings that the client may have.
• It is also iportant for the therapist to remind the client that psychologists are legally mandated to report child abuse.

Question 23

Your client is a 74-year old woman who has recently had a stroke. She tells you that she has beecome very forgetful, has trouble getting anywhere on time, and has trouble remembering where she’s parked her car when she goes shopping. She describes several other problems with her memory and states that she frequently feels confused. The best intervention for this woman is likely to be which of the following?

A. Reminiscence Therapy
B. Family treatment
C. Early Rehabilitative intervention
D. Supportive individual therapy

Answer 23

Early Rehabilitative intervention

EARLY REHABILITATIVE INTERVENTION:

• This is the treatment of choice for stroke disorders

Goal:

• help survivors become as independent as possible and to attain the best possible quality of life.
• Rehabilitation helps stroke survivor relearn skills that are lost when part of the brain is damaged
• Skills include:
  
  • coordinating leg movements in order to walk
  • bathe and dress using one hand if applicable
  • learning how to carry out the steps involved in any complex activity
  • teach survivors new ways of performing tasks to circumvent or compensate for any residual disabilities
• The most important element is carefully directed, well-focused, repetitive practice

http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm

Question 24

As defined by the American Psychological Association, “evidence based practice” in psychology (EBPP) integrates which of the following?

A. the best clinical evidence, clinical expertise, and patient characteristics, and preferences
B. clinical experience, the therapist’s theoretical orientation, and actuarial data
C. clinical judgment, actuarial data, and patient characteristics and preferences
D. the best clinical evidence, the therapist’s theoretical orientation, and patient preferences

Answer 24

The best clinical evidence, clinical expertise, and patient characteristics, and preferences

Question 25

A 14 year old boy has been suspended from school and referred for therapy by his principal. The boy persistently disobeys his teachers and occasionally starts physical fights with his peers. Several times he has been caught stealing items, including money and CDs, from his classmates. The boy’s school grades have been dropping steadily for about a year, and this semester he has begun skipping classes. The boy is attending a new school this year; he was expelled from a private school last spring for destroying school property and lying about it afterwards. His parents divorced when he was 4, and he lives with his mother and stepfather; the couple has been married for 8 years. The boy’s natural father lives in another state and no longer has any contact with the boy or his sister. In the evaluation interview, attended by the boy, mother and stepfather, the mother reports that the boy has stolen liquor from their supply at home. She tries to excuse his behavior, suggesting that he is simply trying to fit in at his new school. The mother and stepfather express deep concern about the boy and are anxious for the psychologist to help him. How should the psychologist treat this boy?

A. social learning family intervention
B. residential treatment
C. individual therapy for the boy to encourage self-exploration and family therapy using structural techniques
D. contingency management

Answer 25

Social learning family intervention

• The boy appears to have Conduct Disorder
• Family interventions are the MOST common treatment for CD and the BEST RESEARCHED METHOD

Social learning family intervention:

• targets coercive parent-child interactions and environmental contingencies and includes:
  
  • parent-child management training
  • psychoeducation for the parents
  • reinforcement of prosocial behaviors and discipline for unacceptable behaviors
  • training in communication

NOTE:

• Outpatient individual psychotherapy that encourages self-exploration and the expression of feelings can actualy have the unwanted effect of producing greater aggression
• Although contingency managment is often a component of treatment for CD, this limited intervention is NOT the best choice available to you
• Outpatient treatment in which the CD child is maintained at home can be effective when the following are present:
  
  • fcning at a sufficiently high level of ego integration
  • he can experience guilt
  • he is capable of empathy
  • he can form meaningful relationships
  • As far as this family is concerned, outpatient treatment is appropriate when the family is strong, able to follow through on tx interventions, and is capable of exercising behavioral control

There is NO indication that he poses a serious danger to others at this time, however, his parents concern and desire to help him suggest outpatient therapy would be approrpriate

• Residential treatment or hospitalization for CD youth can be necessary in extreme cases, otherwise outpatient treatment is appropriate:
  
  • family is not strong, not willing to follow on treatment program
  • client poses a clear danger to others
  • does not fcn at a high level of ego integration, cannot experience guilt, isn’t capable of empathy, and cannot form meaningful relationships

Question 26

A therapist can expect that an Asian-American client will be LEAST likely to do which of the following in therapy?

A. use silence as a way of communicating respect
B. use smiling to express disapproval, disagreeing, or anger
C. avoid expressing strong emotions
D. avoid eye contact when listening to the therapist

Answer 26

Use smiling to express disapproval, disagreeing, or anger

NOTE:

• For some Asian Americans, smiling may demonstrate uneasiness or embarrassment, while for others smiling is avoided because it is considered a sign of weakness
• The other answers describe behaviors characteristic of Asian American’s:
  
  • avoid eye contact when listening to the therapist
  • avoid expressing strong emotions
  • use silence as a way of communicating respect

Question 27

Which of the following is NOT a component of Panic Control Treatment (Barlow & Craske, 2000)?

A. cognitive restructuring
B. breathing retraining
C. interoceptive exposure
D. stress innoculation training

Answer 27

Stress innoculation training

PANIC CONTROL TREATMENT (PCT)
integrates (4) components:

1. Psychoeducation is used to provide clients with information about Panic Disorder and its treatment
2. Cognitive restructuring helps the client identify, challenge, and replace
3. Breathing retraining exercises are used to eliminate hyperventilation
4. Interoceptive conditioning reduces the client’s fear of the bodily sensations associated with anxiety

Stress innoculation training (SIT):

• a comprehensive cognitive-behavioral approach to teaching clients how to cope with stress
• Although SIT and PCT share some specific strategies, SIT is NOT one of thecomponents of PCT

Question 28

Your new therapy client tells you that he has started having trouble with his boss at work and asks what you think he should do about it. As a practitioner of client-centered therapy, you would do which of the following?

A. lead the client by asking probing questions
B. get the clientto think in terms of the “here and now”
C. find some connection between the client’s present behavior and past experiences
D. let the client arrive at his own decisions and insights

Answer 28

Let the client arrive at his own decisions and insights

CLIENT-CENTERED THERAPY (Carl Rogers):

• views the client as the expert of his/her own inner processes
• encourages the client to come to his/her own decisions and insights
• It is a nondirective approach, which de-emphasizes advice-giving, persuasion, diagnosis, and interpretation, and allows for the client self-discovery an problem resolution

Question 29

Treatment for Body Dysmorphic Disorder is most likely to be effective when it includes which of the following?

A. cognitive restructuring and exposure with response prevention
B. cognitive restructuring and anxiety management training
C. DBT and contingency management
D. interpersonal therapy and stimulus control

Answer 29

Cognitive restructuring and exposure with response prevention

NOTE:

• Current treatments for BDD often combine an SSRI with CBT, with therapy including cognitive restructuring and exposure
• Cognitive restructuring involves identifying and replacing problematic thoughts
• Exposure entails exposing the individual to anxiety-arousing situations while preventing him/her from making an avoidance response or engaging in usual anxiety-reducing rituals
  
  • EX: having the individual go to a public place without hiding or camouflaging the bodily defect

Question 30

When working with American Indian/Alaskan Native clients, an effective intervention would combine coordiantion with traditional healers (if appropriate), incorporation of members of the extended family, and a(n):

A. insight-oriented approach
B. reality therapy or a solution-focused approach
C. combination of client-centered and behavioral approaches
D. combination of Adlerian and rational-emotive approaches

Answer 30

Combination of client-centered and behavioral approaches

Question 31

During your initial interview with Ryan R., he tells you that his wife is becoming increasingly unhappy with his attitude. She complains that he doesn’t get along with anyone and blames everybody else for his problems. As Ryan talks about his life, it becomes apparent that he has an externalized coping style: In addition to blaming others for his problems, he is extroverted and manipulative, has low frustration tolerance, and has signs of paranoia. Based on this information, you predict that Ryan would benefit MOST from which of the following therapeutic techniques?

A. social skills training, behavioral contracting, and group interventions
B. therapist-directed imagery, direct instruction, and cathartic discharge
C. paradoxical strategies, therapist advice, and contingency contracting
D. practicing alternative thinking, direct instruction, bibliotherapy

Answer 31

Social skills training, behavioral contracting, and group interventions

NOTE:

• Research on the relationship between a client’s coping style and treatment outcome suggests that clients with an externalized coping style benefit most from techniques that focus on symptom reduction and skill building

EX:

• social skills training
• anger management
• contingency contracting
• practicing alternative thinking
• stimulus control
• group interventions

In contrast, those with an internalized coping style respond best to interpersonal and insight-oriented techniques such as:

• catharsis
• interpretation of transferences and resistances
• diret instruction

Question 32

A psychologist is working with an American Indian client who has suffered symptoms of depression since the death of her grandfather. In terms of religious and spiritual values in this case, what should the psychologist do?

A. incorporate a traditional healer in the treatment process
B. explore and reinforce the therapeutic significance of religious and spiritual events for the client
C. avoid addressing or incorporating these factors until after the client has had complete medical and medication evaluations
D. avoid stereotyping and allow the client to take the lead in discussing the role of these values, if they are significant for her

Answer 32

Explore and reinforce the therapeutic significance of religious and spiritual events for the client

Question 33

Which of the following is considered the most effective treatment for a child or adolescent with Asperger’s disorder?

A. behavior managment
B. cognitive restructuring
C. interpersonal therapy
D. pharmacotherapy

Answer 33

Behavior managment

Question 34

Which of the following is likely to be the most effective treatment for a child with a Specific Phobia?

A. covert sensitization
B. systematic desensitization
C. overcorrection
D. self-instructional training

Answer 34

Systematic desentization

NOTE:

• In-vivo and imaginal exposure are generally considered the most effective treatments for a variety of anxiety disorders
• Systematic desensitization is, by some experts considered to be more appropriate than in-vivo exposure for children who may become overly distressed when they are initially exposed to stimuli that produce a high level of anxiety

COVERT SENSITIZATION:

• based on classical conditioning
• used to reduce or eliminate self-reinforcing bx’s

OVERCORRECTION:

• used to decrease or eliminate undesirable overt bx’s (e.g., aggressive or other acting-out bx’s)

SELF-INSTRUCTIONAL TRAINING:

• used to help impulsive and hyperactive children perform academic and other tasks more successfully

Question 35

As defined by the American Psychological Association, “evidence-based practice in psychology” (EBPP) integrates which of the following?

A. the best clinical evidence, clinical expertise, and patient characteristics and preferences
B. clinical experience, the therapist’s theoretical orientation, and actuarial data
C. clinical judgment, actuarial data, and patient characteristics and preferences
D. the best clinical evidence, the therapist’s theoretical orientation, and patient preferences

Answer 35

The best clinical evidence, clinical expertise, and patient characteristics and preferences

Question 36

A therapist who is using stress innoculation training to help a client deal with job-related stress will first:

A. help the client understand her behavioral and cognitive responses to stressful situations
B. have the client self-monitor her behavior to identify the specific antecedents of stress
C. have the client develop a stress (anxiety) hierarchy
D. use biofeedback to help the client identify and alleviate her physicological reactions to stress

Answer 36

Help the client understand her behavioral and cognitive responses to stressful situations

NOTE:
Stress innoculation is a CBT technique that consists of (3) phases:

1. education (helping the clt understand his/her behavioral and cognitive responses to stressful situations
2. skill acquisition (helping the clt acquire and rehearse a variety of coping skills)
3. application (having the client apply the coping skills to imagined, filmed, and in-vivo stress producing situations)

Question 37

The goals and objectives of treatment are derived from the case formulation and represent the desired outcomes of psychotherapy. Which of the following is NOT true about treatment goals and objectives?

A. they must be achieveable within a reasonable time period given the client’s characteristics, circumstances, and resources
B. the psychologist and the client must agree about them
C. they must be stated in terms that the client understands
D. objectives, but not necessarily goals, should be stated in concrete, quantifiable terms

Answer 37

The psychologist and the client must agree about them

NOTE:

• The clt must accept and be committed to the goals and objectives
• Acceptance and commitment are maximized when the clt has participated in their specification and has publicly accepted them
• The clinician and client may sometimes disagree about tx goals and objectives
• Whenever a disagreement occcurs, the therapist must determine whether the disagreement is manageable
  
  • If the disagreement is not likely (in the therapist’s judgment or as determined empirically) to prevent the patient from reaching his or her goals or to lead to a catastrophe (e.g., financial insolvency), then disagreement is acceptable”
• When this is not the case, consultation or referral is often the best course of action

Question 38

Biofeedback has been shown by research to possibly be effective for all the following conditions except:

A. ADHD
B. Epilepsy
C. Mild Mental Retardation
D. Migraine

Answer 38

Mild Mental Retardation

Question 39

For youth in early to mid-adolescence who have recently developed symptoms of Conduct Disorder but have not exhibited the most serious types of conduct problems, the treatment of choice is most likely to be:

A. family therapy
B. multisystemic therapy
C. day treatment
D. methylphenidate

Answer 39

Family therapy

NOTE:

• The best treatment for Conduct Disorder depends on several factors, including the individual’s age and severity of symptoms.
• However,the experts generally agree that family involvement is an essential component of treatment
• Consequently, family therapy (or parent management training) is often combined with behavior therapy and pharmacotherapy

MULTISYSTEMIC THERAPY (MST):

• used to treat individuals with Conduct Disorder
• designed for youth in mid-to-late adolescence who have exhibited the more serious symptoms of Conduct disorder and may be at risk for institutionalization

DAY TREATMENT:

• useful for individuals who cannot be treated successfully as outpatients and, therefore, would not be the treatment-of-choice for youth who are exhibiting less severe symptoms of CD

PHARMACOTHERAPY:

• used in the treatment of CD but has NOT been found to be an effective intervention when used alone
• Methylphendiate is ordinarily used ONLY when the individual has comorbid sx’s of ADHD

Question 40

The research has demonstrated that tailoring therapy to certain characteristics of the client has beneficial effects. Which of the following efforts to tailor therapy to the client’s characteristics is the most likely to be effective according to research?

A. providing explicit guidance and being high in directives with a client who is highly resistant
B. using symptom-focused, skills building strategies with a client who is highly resistant
C. using interventions that provide opportunities for personal interaction and relatedness with a client who has an anaclitic/sociotropic style
D. providing self-paced, nondirective treatment to a client with several areas of functional impairment

Answer 40

Using interventions that provide opportunities for personal interaction and relatedness with a client who has an anaclitic/sociotropic style

ANACLITIC/SOCIOTROPIC CLIENTS:

• those who are concerned with interpersonal closeness
• benefit from interventions that provide opportunities for personal interaction and relatedness

iNTROJECTIVE/AUTONOMOUS CLIENTS:

• those who are more concerned with developing an integrated identity have better outcomes in therapies that stress autonomy and separation

HIGHLY RESISTANT CLIENTS:

• benefit most from self-control strategies, lower levels of therapist directiveness, and paradoxical interventions

LOW RESISTANT CLIENTS:

• Clients with low resistance have better outcomes when the therapist is high in directiveness and provides explicit guidance

INTERNALIZING COPING STYLE CLTS:

• those who are introverted, inhibited, and self-critical benefit most from interpersonal and insight oriented therapies.

EXTERNALIZING CLIENTS:

• clients with an externalizing coping style (those who are extroverted, impulsive, and task oriented) benefit from symptoms-focused, skill building strategies

CLIENTS WITH FUNCTIONAL IMPAIRMENT:

• profit from longer, more intense treatments that include, when appropriate, psychoactive medication

Question 41

During his first therapy session, Delbert B. tells Dr. Reed that he has come to see her because his girlfriend has said she willleave him if he doesn’t do something about his ‘drinking problem.’ Delbert admits that he sometimes drinks too much. He also says he should probably do something about it but that he doesn’t know where to start.from the perspective of transtheoretical (stage of change) model, Dr. Reed should adopt which of the following role when working with Delbert?

A. experienced coach
B. consultant
C. nurturing parent
D. Socractic teacher

Answer 41

Socractic teacher

NOTE:

SOCRATIC TEACHER:

• Delbert is aware that drinking is a problem for him; but he has come to therapy as the result of his girlfriend’s threat and has not plans for change.
• This indicates that Delbert is in the contemplation stage of change
• For clients in this stage, therapists are most effective if they adopt the role of a Socratic teacher who helps the client achieve insight into his/her condition

EXPERIENCED COACH:

• The role of experienced coach is most effective for a client in the preparation stage.
• The therapist provides encouragement and understanding of the change process

CONSULTANT:

• best for a client in the action stage or maintenance stage
• The therapist offers encouragement and reminders of the learning in the previous stage
• In the maintenance stage, the therapist also provides information to prevent relapse

NURTURING PARENT:

• most effective when the client is in the precontemplation stage

Question 42

A functional behavioral analysis of a child’s acting-out behaviors in school is likely to find that the ________ associated with the behavior is attention from peers or escape from an undesirable activity.

A. primary gain
B. secondary gain
C. discriminative stimulus
D. functional stimulus

Answer 42

Secondary gain

• external benefit received by engaging in a bx
• In the context of acting-out and other problematic behaviors, this benefit often takes the form of attention or escape
  
  • EX: a child might act-out because doing so provides attention from peers or an adult or because it allows him/her to escape an undesirable task or activity

PRIMARY GAIN:

• Refers to the reduction of anxiety that a behavior or sx produces by keeping a conflict out of conscious awareness

DISCRIMINATIVE STIMULUS:

• refers to an environmental event or condition that signals what behavior is expected or what consequence will follow the behavior

FUNCTIONAL STIMULUS:

• refers to the attributes of the discriminative stimulus that exert control over the individual’s behavior
  
  • EX: the color of the traffic light determines whether a driver stops at or continues through an intersection

Question 43

Research by Norcross (2004) and others has found that highly resistant clients benefit most from which of the following?

A. self-control strategies, lower levels of therapist directiveness, and paradoxical interventions
B. more intensive treatments and explicit guidance from the therapist
C. insight-oriented therapies that address the extensive use of particular defense mechanisms
D. interventions that provide opportunities for personal interaction and relatedness

Answer 43

Self-control strategies, lower levels of therapist directiveness, and paradoxical interventions

Question 44

During his first therapy session, Delbert D. tells Dr. Reed that he hascometo see her because his gf has said she will leave him if he doesn’t do something about his “drinking problem.” Delbert admits that he sometimes drinks too much. He also says that he should probably do something about it but that he doesn’t know where to start. From the perspective of the transtheoretical (stage of change), Dr. Reed should adopt which of the following roles when working with Delbert?

A. experienced coach
B. consultant
C. nurturing parent
D. Socratic teacher

Answer 44

Socratic teacher

NOTE:
SOCRACTIC TEACHER:

• Delbert has no plans to change
  
  • He is in the contemplation stage of tx
• Therapists are MOST effective if they adopt the role of the Socractic teacher & help the client achieve insight into his/her condition

EXPERIENCED COACH:

• this role for tp is MOST effective for a client in the PREPARATION stage
  
  • Tp provides encouragement & understanding of the change process

CONSULTANT:

• this role is BEST for clients in the ACTION or MAINTENANCE stage
  
  • Tp offers encouragement & reminders of the learning in the previous stages
  • In the MAINTENANCE stage, tp also provides information to prevent relapse

NURTURING PARENT:

• This role for tp is most effective when the clt is in the PRECONTEMPLATION stage

Question 45

Your new client, Kendall K., age 27, developed symptoms that meet the diagnostic criteria for PTSD several months after being mugged at gun point. Based on the knowledge of research on effective treatments for PTSD, you will most likely use which of the following interventions for Kendall?

A. stress innoculation training and exposure therapy
B. stress innoculation training and hypnotherapy
C. brief dynamic therapy and relaxation therapy
D. supportive counseling and exposure therapy

Answer 45

Stress innoculation training and exposure therapy

NOTE:

Research has found the following treatments to be the most useful for PTSD:

• stress innoculation (anxiety managment)
• exposure therapy
• cognitive therapy
• psychoeducation

Question 46

A client seeks therapy because she wants to change a life-long pattern of passivity. The psychologist and client agree that a treatment goal will be for the client to behave more assertively in her relationships with others. When evaluating the client’s progress toward this goal, the psychologist would be most concerned with which of the following?

A. the extent to which the client reports feeling more assertive
B. the extent to which the client is more assertive in his presence (i.e., the psychologist’s observations)
C. the extent to which the client is able to ask the psychologist for what she wants
D. the extent to which the desired changes have generalized to relationships outside the treatment setting

Answer 46

The extent to which the desired changes have generalized to relationships outside the treatment setting

Question 47

Treatment for a patient with dementia is LEAST likely to include which of the following?

A. skills training for the patient
B. environmental manipulation
C. family treatment
D. medication and regular monitoring

Answer 47

Skills training for the patient

Question 48

A new client is dependent on cocaine and is in the midst of an episode of major depression. What course of treatment is indicated for this client?

A. inpatient program, 12-step program
B. medical evaluation, inpatient program, 12-step program, ongoing therapy
C. medical evaluation, 12-step group, ongoing therapy
D. 12-step group, ongoing therapy

Answer 48

Medical evaluation, inpatient program, 12-step program, ongoing therapy

Question 49

Which of the following is considered to be the most effective treatment for factitious disorder?

A. family or group therapy in an outpatient setting
B. individual therapy and group therapy in an inpatient treatment
C. confrontational therapy in an inpatient setting
D. supportive psychotherapy in an outpatient setting

Answer 49

Supportive psychotherapy in an outpatient setting

Question 50

A psychologist is treating Robert for episodes of depression. Robert has been responsive to treatment, and the psychologist feels his condition has improved dramatically. During their most recent session, Robert says that he has been keeping a secret for a few weeks. He tells his psychologist that he has fallen in love with her.

A. The psychologist should begin the termination process and refer Robert to another therapist
B. The psychologist should continue to treat Robert for his depression but refer Robert to another therapist to address Rober’ts feelings of attraction
C. The psychologist should seek supervision
D. The psychologist should seek consultation

Answer 50

The psychologist should seek consultation

Question 51

When working with American Indian/Alaskan Native clients, an effective intervention would combine coordination with traditional healers (if appropriate), incorportation of members of the extended family, and a(n):

A. insight-oriented approach
B. reality therapy or a solution-focused approach
C. combination of client-centered therapy and behavioral approaches
D. combination of Adlerian and rational-emotive approaches

Answer 51

Combination of client-centered therapy andbehavioral approaches

Question 52

Angela, age 17, comes to therapy at the insistence of her mother with whom she lives. Her mother is not present at the session; but, in her phone call to you prior to the session, she asked you to “do whatever it takes to make my daughter feel better.” Angela tells you that she has come to see you only to appease her mother; and says “I’m fine. It’s just my mom who thinks I’m too secretive and unhappy.” Angela appears lethargic, her affect is restricted, and she startles easily when she hears noises in the hallway. When asked about school, Angela says her grades used to be higher but have dropped this year because she has trouble concentrating, hasn’t been studying much, and has missed some classes. Although Angela will be graduating in two months, she has not applied to college or thought about getting a job, and she tells you that she has no idea what she wants to do with her life. She says that she can’t seem to “live up to the expectations of her parents and teachers” and has never liked “bowing to authority.” Angela’s parents divorced when she was 14, her mother has not remarried, and her mother has sole legal custody of Angela. Angela sees her father twice a month; but, other than saying she wishes she didn’t have to see him anymore, she refuses to talk about him.

What would be the appropriate referral for Angela and her mother?

A. Angela to a physician for a medical check-up
Angela to a psychiatrist for medication evaluation
Angela’s mother for parent educaton
Angela for vocational counseling

B Angela to a psychiatrist for medication evaluation
Angela to a peer support group
Angela to AA and her mother to Al-anon
Angela and her mother for family therapy

C. Angela to a physician for a medical check-up
Angela to a psychiatrist for medication evaluation
Angela to AA and her mother to Al-anon
Angela to an educational specialist

D. Angela to a physician for a medical check-up
Angela to a peer support group
Angela and her mother for family therapy
Angela for vocational counseling

Answer 52

Angela to a physician for a medical check-up
Angela to a peer support group
Angela and her mother for family therapy
Angela for vocational counseling

NOTE:

• Angela to a physician for a medical check-up
  
  • An important part of the assessment process in order to determine if a medical condition accounts for some or all of her symptoms.
• Angela to a peer support group
  
  • Once Angela’s symptoms have remitted sufficiently, she would probably benefit from a peer support group.
  • Group modalities can be particularly useful for adolescents because of the developmental importance placed on peers.
  • if Angela has PTSD, group treatment with other adolescent survivors would offer her an opportunity to share her experience with others who have had similar experiences.
• Angela and her mother for family therapy
  
  • Individual psychotherapy with an adolescent is usually more effective when it takes place in conjunction with family therapy since the adolescent’s disorder is often a symptom of a larger problem that involves the entire family.
• Angela for vocational counseling
  
  • If she expresses an interest in finding some direction for her life, this referral could be useful since she has no idea what she wants to do with her life after graduation

YOU WOULD NOT RIGHTNOW:

• Angela’s mother for parent education

The fact that Angela’s mother insisted that Angela see you suggests she is concerned about her daughter. You’d want to assess the mother-daughter relationship and the mother’s parenting skills, but at this point you don’t have sufficient information to know if Angela’s mother would benefit from parent education.

• Angela to AA and her mother to Al-anon

Some of Angela’s symptoms (e.g., secretiveness and poor school performance) and her age suggest she may be at risk for substance use. Although it is critical that you rule out a substance use disorder, you don’t have enough information right now to conclude that she is an alcoholic who needs to attend AA (or, if she does use alcohol, that she would be a good candidate for AA).

• Angela to an educational specialist

At this point, this referral isn’t a priority since you don’t know the extent to which Angela’s academic problems are due to depression, substance use, or another factor. In addition, Angela is completing school in two months and has no plans at this time to attend college.

Question 53

Assume that Jasmine and her husband are Mexican-American, that they arrived in the United States three years ago, and that they adhere primarily to the traditional values and beliefs of their culture. Given Jasmine’s cultural background, which of the following would be most appropriate while working with her in therapy?

A.

• Rely primarily on nondirective, insight-oriented techniques
• Maintain appropriate professional distance by adopting a neutral attitude
• Be aware that Jasmine may feel embarrassed or ashamed about seeking psychotherapy
• Avoid making direct eye contact with Jasmine

B.

• Rely primarily on nondirective, insight-oriented techniques
• Assign homework to Jasmine that involves the participation of her husband
• After establishing the therapeutic alliance, adopt a personal approach in therapy
• Be aware that Jasmine may feel embarrassed or ashamed about seeking psychotherapy

C.

• Use an active, directive, and structured approach
• Assign homework to Jasmine that involves the participation of her husband
• After establishing the therapeutic alliance, adopt a personal approach in therapy
• Be aware that Jasmine may believe she should defer to Jay in their relationship

D.

• Use an active, directive, and structured approach
• Maintain appropriate professional distance by adopting a neutral attitude
• Be aware that Jasmine is likely to view her symptoms as the result of a lack of harmony with nature
• Be aware that Jasmine may believe she should defer to Jay in their relationship

Answer 53

• Use an active, directive, and structured approach
• Assign homework to Jasmine that involves the participation of her husband
• After establishing the therapeutic alliance, adopt a personal approach in therapy
• Be aware that Jasmine may believe she should defer to Jay in their relationship

NOTE:
Use an active, directive, and structured approach:

• Although it is important to view and treat each client as an individual regardless of his/her cultural background, experts generally recommend that therapists use an active, directive, structured approach with Latino clients.

Assign homework to Jasmine that involves the participation of her husband

• This is consistent with the Latino concept of “familismo,” which emphasizes the desirability and necessity of interdependence (especially among immediate and extended family members) and regards the family as a primary source of support.

After establishing the therapeutic alliance, adopt a personal approach in therapy

• During the initial sessions with a Latino client, it is usually best to adopt a formal stance.
• However, once the therapeutic alliance has been established, it is more desirable to emphasize “personalismo” (personal connection and warmth and physical proximity).

Be aware that Jasmine may believe she should defer to Jay in their relationship

• Latino families are often patriarchal; and, given that Jasmine and her husband adhere to traditional cultural values and beliefs
• Jay is likely to adopt an authoritarian role, while Jasmine defers to his wishes and preferences.

Question 54

Treatment for a patient with dementia is LEAST likely to include which of the following?

A. skills training for the patient
B. environmental manipulation
C. family treatment
D. medication and regular monitoring

Answer 54

Skills training for the patient

Question 55

A new client is dependent on cocaine and is in the midst of an episode of major depression. What course of treatment is indicated for this client?

A. inpatient program, 12-step group
B. medical evaluation, inpatient program, 12-step group, ongoing therapy
C. medical evaluation, 12-step group, ongoing therapy
D. 12-step group, ongoing therapy

Answer 55

Medical evaluation, inpatient program, 12-step group, ongoing therapy

NOTE:

An individual is considered to be at highest risk, particularly since he is depressed and dependent on cocaine. Therefore, medical evaluation and an inpatient program is warranted as the first lines of treatment

Question 56

When treating a patient newly diagnosed with PTSD, the initial focus of treatment typically involves:

A. processing the trauma to prevent development of chronic symptoms
B. teaching coping strategies to deal with sx’s of high arousal and re-experiencing the trauma
C. exposure to avoided stimuli
D. education of family members

Answer 56

Teaching coping strategies to deal with sx’s of high arousal and re-experiencing the trauma

NOTE:

• The needs of PTSD patients can vary, but typically theyfirst need some coping strategies to deal with the post problematic sxs
• A great many patients will not be able to process the trauma immediately until they feel safe with the therapy and have reduced their fear of dealing with the past, so this is not the best initial response
• Similarly patients are not ready for immediate exposure to avoided stimuli, so also not the best choice here
• Not all patients have families or need to have their famiies educated, so this is not the best choice here either

Question 57

A functional assessment of a person with major depressive disorder might include:

A. assessment of current symptoms, daily functioning, and interpersonal functioning
B. assessment of current symptoms, daily functionng, and family history of depressive disorders
C. administering the BDI, collateral interviews with family members, and review of previous treatmnet records
D. psychological testing, psychosocial hx, and reviewof previous treatment records

Answer 57

Assessment of current symptoms, daily functioning, and interpersonal functioning

NOTE:

• A functional assessment is a behavioral analysis of current functioning and behavior
• It makes up only one component of an overall assessment of a patient
  
  • A functional assessment itself would not include family history, psychological testing, review of previous treatment records, or psychosocial history, althoug all of these would be important aspects of a complete assessment of a patient

Question 58

A clinical psychologist who is White meets for the first time with the parents of an African American seven-year-old boy, Darius, who was recently diagnosed by a psychiatrist as having ADHD, Combined presentation, and was prescribed a stimulant. Darius’ father says, ‘I don’t believe in giving fancy names to problems. Darius just needs to mind his parents and his teachers. In response to this statement the psychologist should:

A. educate the parents about ADHD and the role of medications and behavioral interventions
B. enlist the mother’s help in getting the father to engage in treatment
C. offer to refer the family to an African American psychologist more familiar with the family’s culture
D. explore further what both parents believe about Darius’ problem and the ADHD diagnosis.

Answer 58

Explore further what both parents believe about Darius’ problem and the ADHD diagnosis.

NOTE:

• The psychologist’s first step in this situation would be to mobilize family support for Darius’ treatment.
• Having the mother convince the father is probably not the best way to build a productive working relationship with Darius’ family
• A more appropriate way to build rapport and enlist Darius’ parents would be to explore the parent’s thoughts about Darius’ problems and their feelings about his diagnosis
• Attempting to educate Darius’ parents when they appear resistant to his diagnosis would probably be unsuccessful
• At this point in the treatment, it would be unwarranted to refer Darius and his family to an African American psychologist because there is no indication that the psycholoist has limited competence with a multicultural family

Question 59

The client is 23-year-old Linda, a single mother with a 2-year-old son. During the first session with her therapist, Linda says she has not seen the boy’s father (an ex-boyfriend) since she told him she was pregnant with their son. She reports that she has felt sad, lonely, and exhausted for several months and says she can’t figure out what has come over her: She used to cope well with everything and nothing has really changed in her life. Linda works as a waitress three days a week. A neighbor, whose children are grown, cares for Linda’s son while Linda is at work. Linda wishes she had time to look for a better job so that she could pay for “regular” daycare for her son where he would be able to play with other kids. She says she’s not sure what kind of work she could get since she dropped out of high school when she was 16. However, she would like her job to be more fulfilling and to pay more so that she doesn’t have to worry so much about making ends meet. Linda says her son is a “handful” and much too demanding and that she’s been having trouble disciplining him since becoming so overwhelmed. She says she has no one to talk to about her problems.

Which of the following would be the most appropriate referrals for the client described in the exhibit?

A.

• Public financial assistance programs
• Respite care
• Support group for single parents
• Vocational guidance counseling

B.

• Public financial assistance programs
• Legal consultation
• Support group for single parents
• Vocational guidance counseling

C.

• Public financial assistance programs
• Legal consultation
• Family therapist
• Support group for single parents

D.

• Support group for single parents
• Respite care
• Family therapist
• Vocational guidance counseling

Answer 59

Public financial assistance programs
Respite care
Support group for single parents
Vocational guidance counseling

NOTE:

• Respite care services would provide temporary care for Linda’s son, so that she would have the time to pursue other activities that could improve her situation (e.g., attend a support group, find a new job)
• Providing respite care would give her a break from childcare responsibilities and could also prevent her from abusing her son

Question 60

Maria is a 53-year-old woman who was referred by her physician. Maria recently spent time in the hospital after complaining of shortness of breath and painful swelling in her legs. The doctors diagnosed early stage heart failure, prescribed medication, and recommended lifestyle changes, including weight loss and reduced stress. Maria’s husband is angry at her for letting herself gain weight and get sick. He is upset that she can’t work now because he already works hard to support them. At night, Maria wakes up feeling as though she can’t breathe and then can’t fall back asleep because her worries and sense of guilt keep her awake. She blames herself for her illness and wonders whether she should bother following her doctor’s advice. Maria is weepy. She asks whether you believe what her doctors have said about her having a “bad heart.” When you ask her what she believes, she begins crying uncontrollably.

What are the major goals of treatment based on the case presented in the exhibit?

A.

• Reduction of symptoms
• Stress management
• Increased social support
• Re-entry into the workforce

B.

• Reduction of symptoms
• Life review and resolution of unfinished business
• Increased sense of personal control
• Increased social support

C.

• Reduction of symptoms
• Maximizing quality of life
• Monitoring and enforcing compliance with medical treatment
• Increased social support

D.

• Reduction of symptoms
• Increased emotion-focused and problem-focused coping skills
• Adaptation to chronic illness and lifestyle changes
• Increased social support

Answer 60

• Reduction of symptoms
• Increased emotion-focused and problem-focused coping skills
• Adaptation to chronic illness and lifestyle changes
• Increased social support

NOTE:

1. Increased emotion-focused and problem-focused coping skills

• She demonstrates difficulties in coping emotionally with a medical diagnosis – including accepting the fact that it is real – and its accompanying losses
• She has an _inability or unwillingness to engage in problem-focused coping behavior_s, such as lifestyle changes, to improve her situation and medical prognosis; and a probable lack of adequate social and emotional support to cope with a stressful event and its aftermath
  
  • Therefore, while stress managment & coping skills are not wrong answers, increased emotion-focused and problem-focused coping skills is a BETTER answer and more focused.

2. Life review and resolution of unfinished business
   This intervention is commonly used with elderly people approaching death or with individuals facing life-threatening illnesses
   In this case, Maria’s medical condition is serious but can be managed if she follows her doctors’ advice.
3. Increased sense of personal control

• Helping Maria gain an increased sense of personal control is a worthy goal in this case, but you can’t choose it because this answer option doesn’t contain the best collection of treatment goals for this case.
• In addition, this is NOT THE BEST ANSWER because this goal falls under the broader goal of helping Maria develop better coping skills.

Answer 3: Score total = 6
Reduction of symptoms (2)
See the rationale for “1.”
Maximizing quality of life (2
This is an appropriate treatment goal in this case. You can’t choose it, however, because answer “3” doesn’t contain the best collection of treatment goals for this case.
Monitoring and enforcing compliance with medical treatment (0)
The idea of “enforcing” compliance with medical treatments must be ruled out because there is no ethical way for a psychologist to do this. A psychologist can urge, encourage, support, educate, etc., but he/she cannot “force” a client to do something, even if that “something” is in the client’s best interests. If you determined that Maria was a serious danger to herself or gravely disabled because of her mental condition (e.g., she was seriously endangering her health by failing, because of a mental condition, to cooperate with her medical treatments ), then you would have the option of initiating a process to have her involuntary hospitalized for 72 hours (under W.I.C. 5150). Concluding that this action may be appropriate, however, requires you to make many assumptions about Maria’s mental condition and future behavior that are not adequately supported by information in the exhibit.
Increased social support (2)
See the rationale for “1.”

Answer 4: Score total = 8
Reduction of symptoms (2)
See the rationale for “1.”
Increased emotion-focused and problem-focused coping skills (2)
The exhibit indicates that Maria is having difficulty coping emotionally with her medical diagnosis (including accepting the fact that it is real) and the losses that accompany it and is unable or unwilling to engage in problem-focused coping behaviors to improve her situation and medical prognosis. Therefore, helping Maria develop emotion-focused and problem-focused coping skills is a major treatment goal.
Adaptation to chronic illness and lifestyle changes (2)
The rationale for “increased emotion-focused and problem-focused coping skills,” above, applies here, as well.
Increased social support (2)

• See the rationale for “1.”

Question 61

Parents being their 17-year-old daughter Leslie for treatment and you diagnose her with Body Dysmorphic Disorder (BDD). Leslie should be treated with:

A. cognitive behavior therapy
B. family therapy
C. cognitive behavior therapy and medications
D. family therapy and medications

Answer 61

Cognitive behavior therapy and medications

NOTE:

• In the DSM-5, Body Dysmorphic Disorder included in the Obsessive-compusive and related disorder’s chapter

BODY DYSMORPHIC DISORDER:

• the primary distinguishing feature is a preoccupation with one or more perceived defects in appearance (e.g., related to the skin, hair, or nose)
• The perceived flaws are either not observable or slight
• Excessive repetitive behaviors (.e.g., mirror checking, grooming) OR mental acts (e.g., comparing oneself to others) are performed

While family education/therapy to help family members understand the diagnosis and how to help the patient with BDD is usually of benefit, the PRIMARY TREATMENT FOR BDD is a combination of CBT & Medication

CBT for BDD includes:

• psychoeducation
• Cognitive restructuring (challenging cognitive distortions, underlying negative thoughts & beliefs)
• Dealing with problematic behaviors through exposure with response prevention
• Relapse training
• Mirror (perceptual training)
• behavioral experiments
• Medications most commonly prescribed:
  
  • SSRI’s (e.g., Prozac, Paxil), which are also used in the treatment of OCD

Question 62

You work at a college counseling center and have just done an intake on a 19-year-old college student. She describes a 30 pound weight gain in the past 3 months, reports feeling depressed, has difficulties sleeping, and is currently on academic probation. The first referral you should make is:

A. to a psychiatrist
B. for academic counseling
C. to a nutritionist
D. to an internist

Answer 62

To an internist

NOTE:

• Given the potential for underlying medical issues contributing to the current clinical picture, the first referral you should make should be for a medical examination

EX:

• presenting with significant weight gain over a short period of time
• depression
• sleep problems
• academic difficulties
• It would be important to address any general medical condition requiring treatment before proceeding with psychotherapy, a medication evaluation, a referral to a nutritionist, or other treatment (e.g., academic counseling)
• You could alo during your referral to the internist let them know that the patient may be experiencing depression, which may be contributing to her sx’s

Question 63

You are treating a 19-year-old at a college counseling center. She is in crisis, failing several of her classes, and has been isolating herself from friends. She expresses suicidal ideation with vague intent but no imminent plan, and does not require hospitalization. The college counseling center allows six sessions for crisis intervention treatment. You would most likely terminate treatment with her:

A. at the end of six sessions
B. once she has created a plan for academic remediation and is reconnecting with her friends
C. when she no longer expresses suicidal intent
D. when assessment measures indicate she is at low risk for suicide

Answer 63

When she no longer expresses suicidal intent

NOTE:

• Given that she is in crisis, the most important criterion for termination is that she no longer expresses suicidal intent
  
  • It would be inappropriate to terminate after six sessions if she remains in crisis and continues to express suicidal intent
• Ideally within the allotted time (six sessions), this college student will have a plan for academic remediation and be reconnecting with her friends, but we cannot assume this will happen nor would this be an appopriate indication that we can terminate treatment with her.

Question 64

After a thorough psychological assessment, an eight-year-old boy with suicidal ideation has been diagnosed with major depressive disorder, severe. Which of the following statements is most accurate regarding a medication evaluation?

A. The child should not be referred for a medication evaluation because antidepressant medication is risky and often contraindicated in children
B. The child should not be referred for an oupatient medication evaluation because he should be immediately hospitalized
C. The child should be referred for a medication evaluation
D. The child should be referred for a medication evaluation as long as the psychologist provides information about the costs versus the benefits of medicating children

Answer 64

The child should be referred for a medication evaluation

NOTE:

• Because the child has been diagnosed with major depressive disorder, severe, and he has suicidal ideation, he should be referred for a medication evaluation
• It would be stepping oustide of our professional bounds as psychologists to provide information about the costs and benefits of medication, that’s the psychiatrist’s job
• Just because you are experiencing suicidal ideation and have severe depression, it doesn’t mean you immediately have to be hospitalized as the first line of treatment
• Remember that you always want to consider the least restrictive treatment first based on their sx’s and presentation
  
  • There is no indication in the vignette that the child should be immediately hospitalized

Question 65

For the past six months you have been treating a 17-year-old boy in individual therapy. He is a high school junior and is diagnosed with alcohol use disorder, mild. He has also been participating in outpatient substance abuse groups and AA. For no obvious reasonn his condition has worsened rather than improved, and he know meets criteria for an alcohol use disorder, severe. At this point, you should:

A. secure inpatient treatment for his alcohol use disorder
B. assess for danger to self or others
C. seek consultation with his treatment providers
D. consult with the school, with appropriate releases

Answer 65

Seek consultation with his treatment providers

NOTE:

• Your FIRST step at this point SHOULD be to seek consultation with the patient’s other treatment providers (not with AA) who may possibly be able to shed led light on what has caused or is contributing to the patient’s decline
• Patients should always be treated in the least restrictive environment possible thus even though his condition has worsened you should not automatically secure inpatient treatment AND you would still want to consult with his other treatment providers to identify the next best treatment intervention
  
  • Many patients with alcohol use disorder can be successfully treated on an outpatient basis
• After further assessing the situation, you may decide to consult with the school
• At this point, there does not appear to be any need to assess for danger to self or others in the vignette

Question 66

You are treating a 40-year-old Latina immigrant with AIDS who is terminally ill. In session, she tells you that last night the Virgin Mary told her she would be coming to heaven soon. You should:

A. assess for suicidality
B. consider integrating someone from the patient’s spiritual community into treatment
C. consult with her doctor
D. discuss her situation with her family

Answer 66

Consider integrating someone from the patient’s spiritual community into treatment

NOTE:

• One way of providing more effective care to a multicultural patient is to integrate members of the patient’s spiritual community (e.g., a priest, a curandero) into treatment
• Based on what the patient has shared, there is no indication or reason to consult with a doctor or discuss her situation with her family at this point in time
• Although individuals with a medical illness are at an increased risk for suicide, there is NO INDICATION IN THE VIGNETTE that she is suicidal.
  
  • Rather, it appears as though she is attempting to make sense of her illness and impending death by seeing it as part of her spiritual reality —she is going to heaven to meet the Virgin Mary
  • Integrating someone from the patient’s spiritual community at this point might help the therapist optimize the benefit of the patient’s spiritual beliefs in reducing any stress or anxiety about death

Question 67

You are an intern at a community mental health center. Leann, a 34-year-old homemaker, and Gary, a 32-year-old security guard come to treatment. The couple has been experiencing significant marital difficulties for the past 2 years since the birth of their first child who has Down syndrome. In order to treat Gary and Leann in couple’s therapy, you should:

A. notify the couple in writing that you are unlicensed and under the supervisioon of a licensed psychologist
B. ensure that you have worked with couples in conjoint treatment before
C. conduct a clinical interview and mental status exam and administer brief psychological screening tests.
D. assess your level of competence to treat this couple

Answer 67

Assess your level of competence to treat this couple

NOTE:

• CA law stipulates that it is the RESPONSIBILITY OF THE PRIMARY SUPERVISOR (NOT THE INTERN) to inform prospective patients of interns that the intern is unlicensed and under supervision of the licensed psychologist.
• A supervisor could do this by coming into session OR
• the supervisor could prepare a document beforehand for the intern to give to patients letting them know:
• you are an intern working under the license of a supervisor
• the primary supervisor will have full access to the treatment records
• any fees paid for the services of the supervisee must be paid directly to the primary supervisor or employer
• As an INTERN, you do not need to have worked with couple’s before (otherwise how would you have gotten experience)
• HOWEVER, in the absence of clinical experience, you should ensure that you have a basic level of competence to treat couples
  
  • A basic level of competence in the absence of clinical experience would include a theoretical background and some training in couple’s therapy

Question 68

You are treating a 25-year-old graduate student Margaret who is on academic probation. Margaret is diagnosed with an eating disorder. Which of the following would be appropriate interventions and referral?

A. Referral to a nutritionist, medical referral, behavior interventions
B. Cognitive restructuring, medical referral, family therapy
C. Cognitive restructuring, vocational counseling, family therapy
D. Medical referral, behavioral interventions, vocational counseling

Answer 68

Referral to a nutritionist, medical referral, behavior interventions

NOTE:

• An approprate treatment plan for Margaret could include referrals to a nutritionist and a physician, as well as behavior therapy OR CBT to treat her eating disorder
• Because Margaret is a grown woman, there is no reason to initiate family therapy
  
  • Maybe if she were an adolescent, involving the family would be appropriate then

VOCATIONAL COUNSELING:

• helps individuals explore possible career paths
  
  • Since Margaret is on academic probation, she would likely benefit from academic counseling or tutoring, NOT vocational counseling, which is different, and not relevant to her situation

Question 69

Francesa, an Italian woman comes to your office for help. She has an 8-year-old son, Pasqual who is a “handful,” and she notes that she and her husband have been arguing for the last year about whether or not to have a second child. She tearfully states that, “God tells me Pasqual needs a brother.” Francesa asks for your help to calm Pascual down, because she is worried about what her husband Anthony will do if Pasqual “keeps acting this way.” She also tells you that she probably won’t be ableto bring Pasqual to sessions because “Anthony hates psychologists.” At this point, you should:

A. encourage Francesa to bring Pasqual to treatment, letting her know that he can be treated with just one parent’s permission
B. inform Francesa that you cannot treat Pasqual unless both parents consent
C. inform Francesa that under the cirumstances it would probably be best not to treat Pasqual initially
D. encourage Francesa to disucss her concerns with Anthony and see if he would be willing to come to treatment

Answer 69

Inform Francesa that under the cirumstances it would probably be best not to treat Pasqual initially

NOTE:

• The fact that Anthony “hates psychologists,” that there has been a lot of arguing between Francesa and Anthony, and that Francesa expresses worry about what Anthony might do to Pasqual, should dissuade you from asking Francesa to bring her husband into treatment initially
• Although a child CAN be seen in treatment with one parent’s consent (legal custody NOT physical custody), colluding with Francesa to hide Pasqual’s treatment from Anthony would not set a positive framework for treatment
• Therefore, the BEST course of action (with the answer choices given) would be to meet with Francesa initially without Pasqual and identify whether treating her alone (e.g., working on parenting skills) might have a positive impact on the family situation OR whether or not it would be appropriate to invite Anthony to treatment
• Though not listed as an answer choice, you’d want to assess for child abuse (based on Francesa’s report she is afraid what Anthony might do to Pasqual)

Question 70

A clinician develops a treatment plan for a patient dually diagnosed with major depressive disorder, moderate and agoraphobia. The treatment plan includes pleasant activity scheduling, cognitive restructuring, and exposure. This intervention strategy:

A. is inapprorpriate because it targets both disorders simultaneously instead of consecutively.
B. could be strengthened by the addition of a medical referral
C. is appropriate becuase it includes the key effective techniques for both disorders
D. could be strengthened by the addition of a medical referral

Answer 70

could be strengthened by the addition of a medical referral

NOTE:
Though pleasant activity scheduling, exposure, and cognitive restructuring (CBT) are all appropriate treatment interventions for major depression and agoraphobia, a diagnosis of Major depressive disorder, MODERATE definitely requires a medical referral at least, which would strengthen the treatment plan

Question 71

You are a male therapist who for six months have been treating a 45-year-old business executive for marital problems. In the most recent sesion, your patient tells you that he is in love with you.

A. discuss this further and refer the patient to another therapist
B. further discuss issues of his sexual orientation and refer him to a gay/lesbian therapist
C. discuss this further
D. discuss this further and seek consultation

Answer 71

Discuss this further

NOTE:

• Transference is a normal part of therapy and it is not unusual for a patient to “fall in love” with his or her therapist
• Transference should be viewed as an opportunity to further the treatment by exploring the unmet needs the patient is expressing
• It would be both _unecessary and shamin_g to refer your patient to another therapist. You also don’t want to abandon your patient
• While you may want to seek consultation if you are having strong counter-transference to your patient, there is NO INDICATION that consultation is necessary at this point

Question 72

You are treating a patient diagnosed with Generalized Anxiety disorder and alcohol use disorder. Your treatment plan should include:

A. cognitive-behavioral therapy for the substance use disorder, relapse prevention, and flooding with response prevention
B. inpatient detoxification followed by outpatient tretament for the substance use disorder, medication evaluation, and systematic desensitization
C. inpatient detoxification followed by outpatient treatment fo the substance use disorder, relapse prevention, cognitive behavioral therapy
D. cognitive behavioral therapy with relapse prevention, applied relaxation, and medication evaluation

Answer 72

cognitive behavioral therapy with relapse prevention, applied relaxation, and medication evaluation

NOTE:

• A KEY GUIDELINE in treatment planning is that patients should be treated in the least restrictive environment possible
  
  • A psychologist should not automatically recommend inpatient detoxification for patients with alcohol use disorder, as many patients with a substance use disorder can be treated on an outpatient basis
• When treating BOTH alcohol use disorder and GAD, it is important to:
  
  • include a medication evaluation to address possible withdrawal symptoms as well as anxiety symptoms
• Additionally, applied relaxation is an evidence based treatment for GAD