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Psychiatry In-service Training Exam > Treatment - Part 3 of 3 > Flashcards

Treatment - Part 3 of 3 Flashcards

1
Q

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:

A

EMPATHIC VALIDATION

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2
Q

Therapy technique of prescribing a pre-existing sx behavior in relationship therapy

A

PARADOXICAL INTENT

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3
Q

The doctor and patient relationship is described as fiduciary relation is:

A

BASED ON TRUST

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4
Q

“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?

A

FACILITATION, REFLECTION

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5
Q

The purpose of reflective statements during patient interview is for

A

IS TO ENSURE WHAT THE PATIENT SAID IS UNDERSTOOD

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6
Q

What characteristic is associated with better adaptation in individuals >65?

A

UNCRITICAL ACCEPTANCE OF IDEAS

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7
Q

Which Tx modalities provides care for seriously mental ill pts in community via a multidisciplinary Tx team:

A

ASSERTIVE COMMUNITY TREATMENT

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8
Q

Which controlling for health status, which of the following best describes the relationship between retirement and subsequent mortality risk?

A

NO INCREASE IN MORTALITY RISK

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9
Q

Pt in long term psychodynamic psychotherapy attacks therapist for being controlling and uncaring. This is an example of what?

A

TRANSFERENCE

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10
Q

An important technique or goal of cognitive therapy is? (x2)

A

ELICITING AND TESTING AUTOMATIC THOUGHTS

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11
Q

CBT for pts with OCD involves gradually exposing the pt to a feared stimulus and preventing the ritualized response. Over time, this results in decreased anxiety to the stimulus demonstrating which of the following An important technique or goal of cognitive therapy is: (2x)

A

HABITUATION ELICITING AND TESTING AUTOMATIC THOUGHTS

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12
Q

19 y/o pt expresses the belief that she failed a recent midterm exam despite studying a great deal for the test. The patient is convinced that this means she will lose scholarship money and will need to drop out of college. The patient is an excellent student who is prone to excessive worrying. Her belief that she is going to have to drop out of college because she did poorly on the midterm exam is an example of which of the following types of distortion? (x2)

A

CATASTROPHIC THINKING

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13
Q

“could leave more time for questions during class”=”I’m a terrible professor I just talk the whole time”

A

SELECTIVE ABSTRACTION

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14
Q

Which of the following is a principal goal of CBT for panic d/o?

A

USING RESTRUCTURED INTERPRETATION OF DISTURBING SENSATIONS

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15
Q

Goal of CBT for chronic pain tx is:

A

IMPROVE FUNCTIONING DESPITE PAIN

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16
Q

42 M becomes depressed after discovering his wife is having an affair. Pt describes anger at his wife, avoids talking to her. Admits to feeling that the wife’s actions are his fault, that he is a failure as a husband. The pt notes that he has begun to dwell on his past failed relationships, as well as the divorce of his parents. Pt begins CBT for depression. Most appropriate target for this type of therapy in this pt?

A

ASSUMPTIONS OF PERSONAL FAILURE RESULTING FROM THIS CRISIS

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17
Q

Identifying new routes home from work for alcoholic patient is example of which type of therapy?

A

CBT

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18
Q

During treatment of alcohol dependence, the psychiatrist works with a patient on planning for emergencies and drink refusal skills. This is using what therapeutic mentality?

A

CBT

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19
Q

Most commonly used cognitive therapy technique to uncover & modify automatic negative thoughts:

A

SOCRATIC QUESTIONING

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20
Q

Which of the following is characteristic of both interpersonal psychotherapy, CBT?

A

HAS A HERE AND NOW FOCUS

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21
Q

Most appropriate rationale for using humor in CBT:

A

HELPING TO CREATE A NEW PERSPECTIVE ON OTHERWISE DISTORTED COGNITIONS

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22
Q

College student tells psychiatrist “I had an exam today and I’m sure I failed it. Now I will never graduate from college”. Which response is consistent with CBT?

A

“LET’S MAKE LISTS OF THE EVIDENCE FOR AND AGAINST YOU FAILING OUT OF COLLEGE”

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23
Q

From cognitive-behavioral perspective, which is most responsible for major depression?

A

FEELINGS OF DEVALUATION

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24
Q

In CBT, ask patient to keep log for each hour and rate sense of mastery and pleasure experienced. What is this called?

A

ACTIVITY MONITORING

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25
Q

Primary focus of a cognitive therapy approach to suicidal behavior:

A

ADDRESSING ALL OR NOTHING BELIEFS AND HELPING PT LEARN PROBLEM SOLVING

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26
Q

Pt with depression being treated with CBT tells psychiatrist about waking up and being worried about work. Pt has big project that is due in two weeks and is half done, but pt is sure work will not be finished on time. Example of which cognitive error?

A

CATASTROPHIZING

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27
Q

Pt has severe stress and conflict at work, therapist identifies the problem of maladaptive responses based on rigid thought schemas and decides to target automatic negative thoughts through reality checking and guided association. What type of therapy is this?

A

CBT

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28
Q

Flooding, graded exposure, and participant modeling are examples of:

A

CONFRONTATION OF ANXIETY-PROVOKING EXPERIENCES

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29
Q

The LEAST utilized approach used in cognitive therapy in pt w/ substance dependence

A

INTERPRETATION OF INTERACTIONAL PROCESS

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30
Q

A CBT therapist works with a therapist, amongst other things, to identify and correct:

A

OVERGENERALIZATION

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31
Q

In cognitive therapy, “selective abstraction” is what?

A

PATIENT’S FOCUS ON A DETAIL TAKEN OUT OF CONTEXT AND CONCEPTUALIZES A EXPERIENCE BASED ON THIS ELEMENT

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32
Q

When asked about his day, pt replies, “I was late for work b/c I misplaced my keys” then, “I didn’t speak up in the staff mtg.” This is an example of a cognitive error called:

A

SELECTIVE ABSTRACTION

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33
Q

The cognitive error of arbitrary inference is based on:

A

DRAWING A CONCLUSION DESPITE THE ABSENCE OF EVIDENCE OR DESPITE EVIDENCE TO THE CONTRARY

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34
Q

42 y/o pt b/c depressed after discovering his wife is having an affair. Pt describes anger at his wife and avoids talking to her. He admits to feeling his wife’s actions are his fault and that he is a failure as a husband. Pt notes he has begun to dwell on past failed relationships and the divorce of his parents. He begins CBT. The most appropriate target for this type of therapy would be the pt’s:

A

ASSUMPTIONS OF PERSONAL FAILURE RESULTING FROM THIS CRISIS

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35
Q

The behavioral therapy technique in which a pt is exposed to progressively greater fear inducing situations is referred to as:

A

SYSTEMATIC DESENSITIZATION

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36
Q

Behavioral therapy w relaxation training/hierarchy construction/visual imagery?

A

SYSTEMATIC DESENSITIZATION

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37
Q

During psychotherapy, patient describes situation where roommate left the apartment after receiving a call. Patient recalls “im being left out again”. This

A

AUTOMATIC THOUGHTS

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38
Q

What kind of pt with PTSD will have the most favorable prognosis in CBT involving exposure therapy:

A

VICTIM OF A RANDOM VIOLENT ASSAULT

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39
Q

“I always have to work harder than everyone else to succeed” is an example of what kind of statement in cognitive theory

A

A SCHEMA

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40
Q

Professional dancer getting psychotherapy focuses on minor misstep despite acclaim for her performance, example of which cognitive error?

A

SELECTIVE ABSTRACTION

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41
Q

Core feature of practicing mindfulness?

A

EXPERIENCING INTERNAL AND EXTERNAL STIMULI NON-JUDGMENTALLY

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42
Q

Treatment of schizophrenia that focuses on social awareness and basic mental processes to help patients understand intellectual capacity, strength, and limitations?

A

META-COGNITIVE THERAPY

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43
Q

Psychosocial treatment modality most relevant and effective for positive symptoms in schizophrenia?

A

COGNITIVE BEHAVIOR THERAPY

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44
Q

Which is a target of DBT in older adults that is not otherwise included in the standard DBT protocol? (3x)

A

EMOTIONAL CONSTRICTION

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45
Q

When DBT is used to treat patients with borderline, the word dialectical refers to treatment strategies that focus on: (2x)

A

SEARCHING FOR A SYNTHESIS BETWEEN SEEMINGLY CONTRADICTORY IDEAS

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46
Q

23 yo borderline with > 20 SAs seen for DBT. Therapist asks patient to not self harm for 1 yr. Pt replies “ oh sure, that won’t be a problem, believe me” best response?

A

DRAW PATIENT’S ATTENTION TO THE FACT THAT THIS COMMITMENT WILL BE EXTREMELY HARD TO ABIDE BY.

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47
Q

Dialectical behavior therapy is utilized for:

A

BORDERLINE PERSONALITY D/O

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48
Q

DBT patient arrives late with recent relapse on drugs and cutting after marital fight. Highest priority of session should focus on what?

A

SELF INJURIOUS BEHAVIOR

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49
Q

According to DBT theory, which skill should be taught to pts first & regularly practiced in order to facilitate learning of other skills?

A

MINDFULNESS

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50
Q

Which type of therapy has individual sessions to analyze self-destructive cognitions/feelings/actions, and group sessions with skills training to improve relationships and decrease impulsivity?

A

DIALECTICAL BEHAVIORAL THERAPY

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51
Q

Purpose of DBT to diminish what?

A

PARASUICIDAL THOUGHTS

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52
Q

In the individual component of DBT, a therapist spend time in:

A

NURTURING THE PT AND REQUIRING PT TO HELP HERSELF

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53
Q

DBT is unique among commonly employed psychotherapies in that it encourages judicious use of what kind of interview?

A

TELEPHONE CONSULTATION

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54
Q

What is a major therapeutic goal of self-help groups? (3x)

A

OVERCOMING MALADAPTIVE BEHAVIORS

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55
Q

Major task of a group therapy during initial engagement phase is: (2x)

A

DETERMINING LIMITS OF EMOTIONAL SAFETY

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56
Q

The therapist’s initial tasks in starting supportive group therapy are deciding the logistics of organizing planned meetings and selecting patients who can participate in group work. Which of the following would be the appropriate action for the therapist to take next (x2)?

A

CREATE AND MAINTAIN A THERAPEUTIC ENVIRONMENT KEEPING IN MIND THE CULTURE OF THE GROUP

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57
Q

What type of group therapy is based on the unit functioning to maintain its own homeostasis of interacting?

A

FAMILY GROUP THERAPY

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58
Q

Which characteristics of self-help groups distinguishes them from traditional psychotherapy groups?

A

GOALS/OBJECTIVES DON’T ADDRESS INTRAGROUP DYNAMICS

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59
Q

In a group who has met for 6 therapy sessions, one pt has spoken at significant length for past 4 sessions about irrelevant issues & group members have rallied against him. What therapeutic mechanism in group psychotx is being undermined?

A

COHESIVENESS

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60
Q

Which stage of group development has been met when members are less afraid of revealing individual differences so they can participate in experiential learning?

A

NORMING

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61
Q

The group therapist notices that participants in a psychotherapy group experience self- disclosure. Which stage of group development does this demonstrate?

A

STORMING

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62
Q

A therapist plans to create a new outpt psychotherapy group should exclude from group participation Pt w/?

A

ANTISOCIAL PERSONALITY DISORDER

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63
Q

Psychiatrist who uses network therapy to treat patients with addictive disorders is functioning as:

A

A TEAM LEADER

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64
Q

Pt with schizoid personality disorder has elaborate fantasy relationships but has no real friends. Most helpful therapy to assist pt in forming satisfying interpersonal relationships?

A

GROUP THERAPY

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65
Q

Which factor most likely impedes cohesion in daily group therapy on locked adult general psychiatry units?

A

PATIENT TURNOVER

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66
Q

In terms of group dynamics, the confirmation of reality by comparing one’s own conceptualizations with those of other group members and thereby correcting interpersonal distortions is known as what?

A

CONSENSUAL VALIDATION

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67
Q

Stage of group development where members testing norms, competing w/ each other, seeking autonomy:

A

DIFFERENTIATION

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68
Q

Exclude a patient from a weekly outpatient group treatment group if they have a:

A

TENDENCY TO ASSUME DEVIANT ROLE

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69
Q

Differentiation stage of group development is best characterized by what dynamic:

A

TESTING AND COMPETITION

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70
Q

What is the therapeutic factor of treating bulimics in group therapy to openly disclose personal attitudes toward body image and give detailed experiences with binging/purging?

A

UNIVERSALITY

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71
Q

Pt in group therapy calls another patient at home to object to something said in session, this is called:

A

ACTING OUT

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72
Q

During a group therapy session female pt describes past experiences of sexual abuse by her father. Pt states that at times she feels depressed and hopeless, and has intense thoughts of killing herself. Another pt in the groups states, “I feel the same way, and I’ve felt like this for a long time.” Second pt’s admission is reflective of which of the following therapeutic factors in group therapy?

A

CONTAGION

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73
Q

Which of the following diagnoses is associated with high hypnotizability potential? (2x)

A

DISSOCIATIVE DISORDER

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74
Q

Hypnotizability most strongly predicted by:

A

CAPACITY FOR IMAGINATION

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75
Q

Which of the following hypnotic techniques is used for most pts?

A

ENCOURAGING THE PT TO USE INNER RESOURCES FOR ADAPTIVE COPING STRATEGIES

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76
Q

Ability to get so caught up in an experience that one loses awareness of surroundings is called:

A

HYPNOTIZABILITY

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77
Q

Fact about hypnosis:

A

HYPNOTIZABILITY IS A MEASURABLE TRAIT

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78
Q

When used as a tx following a traumatic event, hypnosis has been found to:

A

SAFELY DECREASE PAIN AND STRESS IN THOSE WHO ARE HYPNOTIZABLE

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79
Q

Absorption, dissociation, and suggestibility converge during:

A

HYPNOTIC CONCENTRATION

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80
Q

Hypnosis would be contraindicated in the treatment of patients with:

A

PARANOIA

81
Q

32 y/o pt is considering a course of hypnosis to help quit smoking, but voices concerns. Pt expresses worry about potential harm of hypnosis if not done properly. What would be the best initial response for the psych MD to make to pt regarding this concern?

A

A TRANCE PROCEDURE IS BENIGN AND REVERSIBLE BY CALM REASSURANCE

82
Q

During a hypnosis session a pt reports reduced awareness of sounds and other distractions in therapist’s office. The pt’s report is reflective of what component of hypnotic concentration?

A

ABSORPTION

83
Q

Most important guideline re: hypnosis

A

RECORD ON VIDEOTAPE

84
Q

Common experience of becoming so caught up in a movie that one ignores the environment is example of what component of hypnotic process?

A

ABSORPTION

85
Q

Which of the following is the best use of hypnosis in a patient with chronic PTSD with severe dissociative symptoms due to childhood abuse?

A

LEARNING TO GAIN VOLITIONAL CONTROL OVER DISSOCIATION

86
Q

In the middle phase of interpersonal psychotherapy (IPT), the therapist focuses on the patient’s: (4x)

A

CURRENT RELATIONSHIPS

87
Q

In pt with MDD and social phobia the IPT targets social isolation by (2x):

A

WORKING WITH THE PT TO HELP INCREASE SOCIAL CONTACTS, STRENGTHEN THE CURRENT RELATIONSHIPS.

88
Q

During the initial phase of interpersonal psychotherapy (ITP), what problem is the therapist most likely to identify for therapeutic focus with the patient (x2)?

A

ROLE TRANSITION

89
Q

F psychiatrist has been treating a 32 y/o married F pt w weekly psychotherapy for depressive sx, ambivalence about marriage. Therapy progressing well. Pt just learned she is pregnant, explores conflicted feelings about terminating pregnancy and her fears that unplanned pregnancy would trap her in marriage. Uncharacteristically, psychiatrist speaks strongly to pt about reasons not to make such a choice. Pt responds by saying “you are not going to make me feel guilty about this!” What statement would be most appropriate for therapist to make in response?

A

“YOU FELT I WAS IMPOSING A MORAL JUDGMENT ONTO YOU, AND, APPROPRIATELY, YOU OBJECTED.”

90
Q

Which interview technique is illustrated by validating a patient’s inappropriate ED visit (eg. superficial wrist laceration) but also transitioning to their emotional needs?

A

CONFRONTATION

91
Q

Interpersonal social rhythm therapy in bipolar focuses on what?

A

LIFESTYLE REGULARITY

92
Q

IPT of adults w/ depression begins w/assessment of pt’s adjustment to stressful life events, role transitions and disputes, and:

A

QUALITY OF SOCIAL CONNECTIONS

93
Q

Name a treatment modality that explicitly emphasizes giving pts a formal psych Dx and assigning them sick role:

A

INTERPERSONAL THERAPY

94
Q

75 y/o pt has begun to experience insomnia and fatigue after the death of her husband. She describes feeling “down in the dumps”. She was previously active with many friends and social outlets. Psych MD decides that treatment should focus on pt’s grief as the primary problem in order to aid mourning and facilitate pt’s reintroduction into outside activities and relationships. What therapy is best?

A

INTERPERSONAL THERAPY

95
Q

Intentionally assigning the sick role to a pt which serves to give the pt the permission and responsibility in order to recover is a tenet of which form of psychotherapy?

A

INTERPERSONAL THERAPY

96
Q

Which Tx is contraindicated in initial treatment of pt experiencing domestic violence? (4x)

A

CONJOINT MARITAL THERAPY

97
Q

What best illustrates a double bind in a family? (3x)

A

BETTY’S PARENTS ENCOURAGE COLLEGE, BUT COMPLAIN THAT EXPENSES WILL BE A HARDSHIP FOR THE FAMILY

98
Q

Which psychosocial therapies for pts w/ schizophrenia has been shown to reduce relapse rates? (3x)

A

FAMILY PSYCHOEDUCATIONAL THERAPY

99
Q

When conducting marital therapy with a couple who beginS to talk about divorce, what should the psychiatrist’s stance be? (2x)

A

FOCUS ON THE COUPLE’S RESPONSIBILITY TO DECIDE THE FUTURE OF THEIR RELATIONSHIP

100
Q

What response is consistent with supportive therapy when a patient tells you their marital conflicts have resolved thanks to you the therapist?

A

“IM HAPPY TO HEAR THAT THINGS ARE GOING WELL AT HOME AND THAT OUR WORK TOGETHER HAS BEEN HELPFUL”

101
Q

Wrap around process for youth

A

AN INDIVIDUALIZED, FAMILY-DRIVEN AND YOUTH-GUIDED TEAM PLANNING PROCESS

102
Q

On initial psych eval, pt tells dr about recent infidelity, wants to make amends with spouse, what response would get additional info from pt?

A

TELL ME MORE ABOUT HOW THIS STARTED

103
Q

Which of the following statements best describes the current conceptualization of family that informs family system theories and treatment approaches?

A

FUNCTIONING FAMILIES TEND TO HAVE CERTAIN SHARED CHARACTERISTIC ATTRIBUTES RATHER THAN COMMON STRUCTURES

104
Q

Dysfunctional process in systemic therapy illustrated by mother telling 15yo son to confront his father about his excessive drinking.

A

TRIANGULATION

105
Q

Which of the following approaches is likely to obtain the most accurate information on the factors influencing a family’s level of functioning

A

FAMILY COPING STRATEGIES IN RESPONSE TO PAST STRESSORS

106
Q

During the initial interview of a couple presenting for therapy it is helpful to point out that the focus of therapy is primarily on the:

A

RELATIONSHIP PROBLEM

107
Q

Typical phase of life problem in middle adulthood?

A

CARING FOR BOTH ONE’S CHILDREN AND PARENTS

108
Q

9 yo f bib-parents for outpt evaluation due to behavior difficulties at home. Port daughter “explodes” when she doesn’t get her way. Bossy with friend. On interview, child is calm, cooperative and interactive, denies SI/HI and states “sometimes I just get mad.” What is the most appropriate level of care?

A

SEND THE PT HOME WITH PARENTS

109
Q

9 yo f bib-parents for outpt evaluation due to behavior difficulties at home. Port daughter “explodes” when she doesn’t get her way. Bossy with friend. On interview, child is calm, cooperative and interactive, denies SI/HI and states “sometimes I just get mad.” At a follow up interview the physician learns the outbursts are related to parental disputes. What is the next treatment step?

A

EXPLORE REASONS FOR PARENTAL DIFFERENCES

110
Q

9 y/o female bib-parents for outpt evaluation due to behavior difficulties at home. Reports daughter “explodes” when she doesn’t get her way. Bossy with friend. On interview, child is calm, cooperative and interactive, denies SI/HI and states, “sometimes I just get mad.” Which is the most appropriate initial diagnostic step?

A

OBTAIN A TEACHER REPORT

111
Q

Which of the following principles is most commonly endorsed in parent management training programs for treatment of oppositional defiant disorder?

A

PARENTAL ATTENTION FOR PROSOCIAL BEHAVIOR

112
Q

Beginning phase of therapy w child who was incest victim should first focus on what?

A

DEALING WITH PRIOR BETRAYAL AND ESTABLISHING TRUST WITH THE THERAPIST

113
Q

5 y/o enacts fight between two dolls. What should therapist do?

A

DESCRIBE THE DOLL’S AFFECT WITHOUT ATTRIBUTING ANGER TO THE CHILD

114
Q

Couple has sought couples’ therapy due to chronic episodic fighting. Solution focused therapist might make which intervention?

A

BETWEEN NOW & NEXT TIME, I WANT EACH OF YOU TO THINK ABOUT WHAT THE TWO OF YOU ARE DOING DIFFERENTLY IN TIMES OF NOT ARGUING

115
Q

Interview w/ a pt w/ schizophrenia evokes feelings of confusion and frustration in the interviewer when the pt becomes silent. What response by the therapist would be the best approach to establishing rapport?

A

ACKNOWLEDGING THE INTERVIEWER’S FRUSTRATION AND INQUIRING IF THE PT FEELS SIMILARLY

116
Q

In cases of recovered memory, the role of the therapist is to:

A

DEMONSTRATE EMPATHY FOR THE PATIENT WITHOUT ENDORSEMENT OF THE MEMORY

117
Q

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

A

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

118
Q

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

A

COLLECTING FEEDBACK FROM THE PT ABOUT THE TREATMENT

119
Q

Pt is often tardy. Supervisor warns not to be late. Pt has anxiety about losing job. When father dies he leaves town w/o telling supervisor. Again given warning. Next day a train causes him to be late. In therapy, the overlapping of multiple potential causes for tardiness is an example of what?

A

OVERDETERMINATION

120
Q

Woman is unable to achieve orgasm with her partner. Treatment = directed masturbation + ?

A

COUPLES THERAPY

121
Q

The basis for self-psychological strategy in marital therapy is best indicated by what?

A

DEMONSTRATING CONFLICTS ARISING FROM EACH SPOUSE’S NEED TO HAVE HIS/HER NEEDS MET BY OTHER

122
Q

Couples therapy: what is the goal of acceptance work?

A

EACH PARTNER TAUGHT TO UNDERSTAND OTHER’S POSITION & RELEASE STRUGGLE TO CHANGE HIM OR HER

123
Q

During initial eval of an individual for couple’s therapy, it is most critical to ask about:

A

DOMESTIC VIOLENCE

124
Q

28yo homosexual M reports being victim of domestic violence and has not reported. What is the best response for the psychiatrist to make?

A

LISTEN TO PT’S CONCERNS AND EXPLORE THEM

125
Q

A new psychotherapy patient arrives for a first appointment, accompanied by the spouse. The pt asks if the spouse can be present during the interview. Which of the following is the most appropriate immediate response by the psychiatrist?

A

“CERTAINLY, IF THAT IS YOUR WISH, BUT I’D ALSO LIKE TO SPEAK WITH YOUR PRIVATELY AT SOME POINT.”

126
Q

Couples dissatisfied with each other and progressing toward divorce has which of the following?

A

EXPRESSION OF CONTEMPT AND STONEWALLING DURING INTERACTIONS

127
Q

Couples therapy is contraindicated in which of the following situations?

A

UNEQUAL MOTIVATION

128
Q

family psychoeducation programs for psychotic disorders reduce symptom severity and relapse risk by reversing what?

A

FAMILY MEMBERS EXPRESS CRITICISM, HOSTILITY AND BLAME TOWARDS THE PATIENT

129
Q

This best describes the technique of reframing in family therapy:

A

NEGATIVELY EXPRESSED FEELING OR BEHAVIORS ARE EXPRESSED IN POSITIVE TERMS

130
Q

Structural model of family therapy characterizes family as

A

COMPLEX SYSTEM COMPRISED OF ALLIANCES AND RIVALRIES

131
Q

According to strategic and structural family therapies – underlying basis for analysis of symptoms in children, parents, and families

A

OBSERVABLE AND REPORTED FAMILY BEHAVIOR SEQUENCES

132
Q

What is an important technique of structural family therapy?

A

OBSERVING THE RELATIVE INFLUENCE OF EACH FAMILY MEMBER ON THE OUTCOME OF AN ACTIVITY

133
Q

Which practice is common to all couple and family therapies and contributes to a therapeutic outcome?

A

CONCEPTUALIZING DIFFICULTIES IN RELATIONAL TERMS

134
Q

Therapist validates family’s strengths/resources in dealing w pt’s schizophrenia at bi-weekly family meeting. What stage of family psychoeducational model is this?

A

ENGAGEMENT

135
Q

According to both strategic and structural family therapies, which of the following is the underlying basis for analysis of symptoms and dysfunction in children, parents, and families?

A

OBSERVABLE AND REPORTED FAMILY BEHAVIOR SEQUENCES

136
Q

12 yo arguing w his single parent mother. Mother threatens consequences and child runs to grandmother who then scolds mother for being too harsh. Family dynamic is reflective of?

A

TRIANGULATION

137
Q

What type of family therapy uses paradoxical directives, such as prescribing the symptom or behavioral sequence?

A

STRATEGIC

138
Q

In what type of family therapy are the concepts of family hierarchies, boundaries, coalitions, and alliances seen as core concepts?

A

STRUCTURAL

139
Q

Contraindication to family therapy

A

STRONG RELIGIOUS OR CULTURE BELIEFS AGAINST OUTSIDE INTERVENTION

140
Q

In family therapy, a previously distant couple begins to communicate more frequently and intimately. After this happened the daughter who used to be close to mom, and has become less so as a consequence of above therapy changes, is more hostile to father. This behavior is called:

A

TRIANGULATION

141
Q

Pt w/ schizophrenia has recently been discharged from the hospital after a first psychotic episode. Family-oriented therapy goals should include?

A

EDUCATING THE FAMILY ABOUT THE PATIENT’S ILLNESS AND PROVIDING SUPPORT FOR IMMEDIATE PROBLEMS

142
Q

During family meeting for 75yo pt admitted for MI, how to address family unwilling to participate in discussion?

A

IDENTIFY THE INABILITY OR UNWILLINGNESS TO DISCUSS AS ONE OF THE FAMILY’S PROBLEMS

143
Q

According to structural family therapy, what is the indicator of normal family functioning?

A

WELL DEFINED BOUNDARY BETWEEN PARENTS AND CHILDREN THAT PERSEVERES AUTHORITY AND FACILITATES OPEN COMMUNICATION

144
Q

In the structural model of family therapy, the family is viewed as a:

A

SINGLE, INTERRELATED SYSTEM WITH AN EMPHASIS ON BOUNDARIES BETWEEN THE GENERATIONS.

145
Q

A couple in therapy for relationship difficulties that are related in part to one partner’s frequent nagging of the other. The therapist recommends that the nagging partner intentionally nag the other partner three times a day, regardless of whether there is an urge to do so or not. This technique of prescribing the symptom is an example of:

A

PARADOXICAL INTENT

146
Q

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

A

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

147
Q

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

A

RESISTANCE

148
Q

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

A

BRINGING UNCONSCIOUS CONFLICT INTO AWARENESS

149
Q

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

A

I CANNOT BE TRUSTED TO MAKE A GOOD DECISION

150
Q

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

A

TURNING AGAINST THE SELF AS A DEFENSE AGAINST INTOLERABLE ANGER.

151
Q

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

A

THE THERAPISTS TOTAL EMOTIONAL REACTION TO THE PATIENT

152
Q

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

A

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

153
Q

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

A

PSYCHODYNAMIC PSYCHOTHERAPY

154
Q

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

A

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

155
Q

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

A

ACUTE EXACERBATION OF CHRONIC SCHIZOPHRENIA

156
Q

Use of meds with psychodynamic psychotherapy optimal when:

A

MEANINGS AND EFFECTS OF MEDS INTEGRATED INTO PT’S UNDERSTANDING

157
Q

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

A

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

158
Q

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

A

COLLECTING FEEDBACK FROM THE PT ABOUT THE TREATMENT

159
Q

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

A

DISCREPANCY

160
Q

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

A

CLARIFY AND RELENTLESSLY CONFRONT THE PT’S DEFENSES

161
Q

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

A

A PRACTICAL/SUPPORTIVE APPROACH

162
Q

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

A

PRACTICAL WORKING THROUGH OF CONFLICT BY TRANSFERENCE INTERPRETATION

163
Q

Determines if pt has ego strength for therapy

A

ASSESSMENT OF QUALITY OF RELATIONSHIPS

164
Q

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

A

DISCUSSION OF TRANSFERENCE IN THE LATTER

165
Q

Primary intervention in highly expressive psychotherapy:

A

INTERPRETATION

166
Q

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

A

INTERPRETATION

167
Q

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

A

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

168
Q

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

A

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

169
Q

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

A

WEAKENED OR ABSENT PSYCHIC STRUCTURES

170
Q

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

A

WORKING THROUGH

171
Q

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

A

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

172
Q

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

A

MATURE OBJECT RELATIONS

173
Q

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

A

INTERPRET PATIENT’S LONGING TO IDENTIFY WITH THE THERAPIST.

174
Q

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

A

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

175
Q

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

A

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

176
Q

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

A

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

177
Q

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

A

EMPATHIC VALIDATION

178
Q

Developmental stage in psychodynamic group therapy characterized by intimacy:

A

WORKING GROUP

179
Q

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

A

UTILIZE THE TRANSFERENCE TO STRENGTHEN THE THERAPEUTIC ALLIANCE

180
Q

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

A

BRIEF PSYCHIATRIC RATING SCALE

181
Q

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

A

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

182
Q

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

A

STABILIZE PT’S FUNCTIONING, STRENGTHEN PT DEFENSES

183
Q

Patient cursed at daughter, therapist feels angry, next step

A

EXPRESS APPRECIATION, LOOK TO UNDERSTAND ACTION, LOOK FOR OPPORTUNITIES

184
Q

Role of therapist in motivational interviewing

A

POINTS OUT DISCREPANCY BETWEEN BEHAVIORAL AND PERSONAL GOALS TO MOTIVATE CHANGE

185
Q

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

A

A CHANGE TO EXPRESS FEELINGS OR LOSS

186
Q

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

A

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

187
Q

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

A

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

188
Q

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

A

DOCUMENT CAREFULLY THE UNFOLDING PROCESS AND OBTAIN SUPERVISION

189
Q

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

A

EDUCATE PATIENT ON NATURE OF ILLNESS AND TREATMENT

190
Q

Which best defines goals of supportive psychotherapy?

A

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

191
Q

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

A

REASSURANCE

192
Q

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

A

REINFORCES EGO DEFENSES

193
Q

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

A

ADVISING

194
Q

An important technique in supportive therapy is…

A

WORKING PRIMARILY IN THE PRESENT

195
Q

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

A

“YOU’RE DOING FINE, GO ON.”

196
Q

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

A

SUPPORTIVE PSYCHOTHERAPY

197
Q

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

A

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

198
Q

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

A

ACKNOWLEDGE THE PATIENT’S FEAR

199
Q

An example of “change talk” elicited in motivational interviewing

A

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

Psychiatry In-service Training Exam (13 decks)

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