Treatment - Part 3 of 3 Flashcards
In psychotherapy a pt states that he still feels devalued by criticism of father. Therapist comment: It must hurt when you are treated that way. This is example of:
EMPATHIC VALIDATION
Therapy technique of prescribing a pre-existing sx behavior in relationship therapy
PARADOXICAL INTENT
The doctor and patient relationship is described as fiduciary relation is:
BASED ON TRUST
“When you mentioned your sibling’s problem, your voice cracked and, for a moment, I thought I heard anger in your voice.” Which interviewing technique does psychiatrist use here?
FACILITATION, REFLECTION
The purpose of reflective statements during patient interview is for
IS TO ENSURE WHAT THE PATIENT SAID IS UNDERSTOOD
What characteristic is associated with better adaptation in individuals >65?
UNCRITICAL ACCEPTANCE OF IDEAS
Which Tx modalities provides care for seriously mental ill pts in community via a multidisciplinary Tx team:
ASSERTIVE COMMUNITY TREATMENT
Which controlling for health status, which of the following best describes the relationship between retirement and subsequent mortality risk?
NO INCREASE IN MORTALITY RISK
Pt in long term psychodynamic psychotherapy attacks therapist for being controlling and uncaring. This is an example of what?
TRANSFERENCE
An important technique or goal of cognitive therapy is? (x2)
ELICITING AND TESTING AUTOMATIC THOUGHTS
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)
HABITUATION ELICITING AND TESTING AUTOMATIC THOUGHTS
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)
CATASTROPHIC THINKING
“could leave more time for questions during class”=”I’m a terrible professor I just talk the whole time”
SELECTIVE ABSTRACTION
Which of the following is a principal goal of CBT for panic d/o?
USING RESTRUCTURED INTERPRETATION OF DISTURBING SENSATIONS
Goal of CBT for chronic pain tx is:
IMPROVE FUNCTIONING DESPITE PAIN
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?
ASSUMPTIONS OF PERSONAL FAILURE RESULTING FROM THIS CRISIS
Identifying new routes home from work for alcoholic patient is example of which type of therapy?
CBT
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?
CBT
Most commonly used cognitive therapy technique to uncover & modify automatic negative thoughts:
SOCRATIC QUESTIONING
Which of the following is characteristic of both interpersonal psychotherapy, CBT?
HAS A HERE AND NOW FOCUS
Most appropriate rationale for using humor in CBT:
HELPING TO CREATE A NEW PERSPECTIVE ON OTHERWISE DISTORTED COGNITIONS
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?
“LET’S MAKE LISTS OF THE EVIDENCE FOR AND AGAINST YOU FAILING OUT OF COLLEGE”
From cognitive-behavioral perspective, which is most responsible for major depression?
FEELINGS OF DEVALUATION
In CBT, ask patient to keep log for each hour and rate sense of mastery and pleasure experienced. What is this called?
ACTIVITY MONITORING
Primary focus of a cognitive therapy approach to suicidal behavior:
ADDRESSING ALL OR NOTHING BELIEFS AND HELPING PT LEARN PROBLEM SOLVING
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?
CATASTROPHIZING
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?
CBT
Flooding, graded exposure, and participant modeling are examples of:
CONFRONTATION OF ANXIETY-PROVOKING EXPERIENCES
The LEAST utilized approach used in cognitive therapy in pt w/ substance dependence
INTERPRETATION OF INTERACTIONAL PROCESS
A CBT therapist works with a therapist, amongst other things, to identify and correct:
OVERGENERALIZATION
In cognitive therapy, “selective abstraction” is what?
PATIENT’S FOCUS ON A DETAIL TAKEN OUT OF CONTEXT AND CONCEPTUALIZES A EXPERIENCE BASED ON THIS ELEMENT
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:
SELECTIVE ABSTRACTION
The cognitive error of arbitrary inference is based on:
DRAWING A CONCLUSION DESPITE THE ABSENCE OF EVIDENCE OR DESPITE EVIDENCE TO THE CONTRARY
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:
ASSUMPTIONS OF PERSONAL FAILURE RESULTING FROM THIS CRISIS
The behavioral therapy technique in which a pt is exposed to progressively greater fear inducing situations is referred to as:
SYSTEMATIC DESENSITIZATION
Behavioral therapy w relaxation training/hierarchy construction/visual imagery?
SYSTEMATIC DESENSITIZATION
During psychotherapy, patient describes situation where roommate left the apartment after receiving a call. Patient recalls “im being left out again”. This
AUTOMATIC THOUGHTS
What kind of pt with PTSD will have the most favorable prognosis in CBT involving exposure therapy:
VICTIM OF A RANDOM VIOLENT ASSAULT
“I always have to work harder than everyone else to succeed” is an example of what kind of statement in cognitive theory
A SCHEMA
Professional dancer getting psychotherapy focuses on minor misstep despite acclaim for her performance, example of which cognitive error?
SELECTIVE ABSTRACTION
Core feature of practicing mindfulness?
EXPERIENCING INTERNAL AND EXTERNAL STIMULI NON-JUDGMENTALLY
Treatment of schizophrenia that focuses on social awareness and basic mental processes to help patients understand intellectual capacity, strength, and limitations?
META-COGNITIVE THERAPY
Psychosocial treatment modality most relevant and effective for positive symptoms in schizophrenia?
COGNITIVE BEHAVIOR THERAPY
Which is a target of DBT in older adults that is not otherwise included in the standard DBT protocol? (3x)
EMOTIONAL CONSTRICTION
When DBT is used to treat patients with borderline, the word dialectical refers to treatment strategies that focus on: (2x)
SEARCHING FOR A SYNTHESIS BETWEEN SEEMINGLY CONTRADICTORY IDEAS
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?
DRAW PATIENT’S ATTENTION TO THE FACT THAT THIS COMMITMENT WILL BE EXTREMELY HARD TO ABIDE BY.
Dialectical behavior therapy is utilized for:
BORDERLINE PERSONALITY D/O
DBT patient arrives late with recent relapse on drugs and cutting after marital fight. Highest priority of session should focus on what?
SELF INJURIOUS BEHAVIOR
According to DBT theory, which skill should be taught to pts first & regularly practiced in order to facilitate learning of other skills?
MINDFULNESS
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?
DIALECTICAL BEHAVIORAL THERAPY
Purpose of DBT to diminish what?
PARASUICIDAL THOUGHTS
In the individual component of DBT, a therapist spend time in:
NURTURING THE PT AND REQUIRING PT TO HELP HERSELF
DBT is unique among commonly employed psychotherapies in that it encourages judicious use of what kind of interview?
TELEPHONE CONSULTATION
What is a major therapeutic goal of self-help groups? (3x)
OVERCOMING MALADAPTIVE BEHAVIORS
Major task of a group therapy during initial engagement phase is: (2x)
DETERMINING LIMITS OF EMOTIONAL SAFETY
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)?
CREATE AND MAINTAIN A THERAPEUTIC ENVIRONMENT KEEPING IN MIND THE CULTURE OF THE GROUP
What type of group therapy is based on the unit functioning to maintain its own homeostasis of interacting?
FAMILY GROUP THERAPY
Which characteristics of self-help groups distinguishes them from traditional psychotherapy groups?
GOALS/OBJECTIVES DON’T ADDRESS INTRAGROUP DYNAMICS
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?
COHESIVENESS
Which stage of group development has been met when members are less afraid of revealing individual differences so they can participate in experiential learning?
NORMING
The group therapist notices that participants in a psychotherapy group experience self- disclosure. Which stage of group development does this demonstrate?
STORMING
A therapist plans to create a new outpt psychotherapy group should exclude from group participation Pt w/?
ANTISOCIAL PERSONALITY DISORDER
Psychiatrist who uses network therapy to treat patients with addictive disorders is functioning as:
A TEAM LEADER
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?
GROUP THERAPY
Which factor most likely impedes cohesion in daily group therapy on locked adult general psychiatry units?
PATIENT TURNOVER
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?
CONSENSUAL VALIDATION
Stage of group development where members testing norms, competing w/ each other, seeking autonomy:
DIFFERENTIATION
Exclude a patient from a weekly outpatient group treatment group if they have a:
TENDENCY TO ASSUME DEVIANT ROLE
Differentiation stage of group development is best characterized by what dynamic:
TESTING AND COMPETITION
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?
UNIVERSALITY
Pt in group therapy calls another patient at home to object to something said in session, this is called:
ACTING OUT
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?
CONTAGION
Which of the following diagnoses is associated with high hypnotizability potential? (2x)
DISSOCIATIVE DISORDER
Hypnotizability most strongly predicted by:
CAPACITY FOR IMAGINATION
Which of the following hypnotic techniques is used for most pts?
ENCOURAGING THE PT TO USE INNER RESOURCES FOR ADAPTIVE COPING STRATEGIES
Ability to get so caught up in an experience that one loses awareness of surroundings is called:
HYPNOTIZABILITY
Fact about hypnosis:
HYPNOTIZABILITY IS A MEASURABLE TRAIT
When used as a tx following a traumatic event, hypnosis has been found to:
SAFELY DECREASE PAIN AND STRESS IN THOSE WHO ARE HYPNOTIZABLE
Absorption, dissociation, and suggestibility converge during:
HYPNOTIC CONCENTRATION
Hypnosis would be contraindicated in the treatment of patients with:
PARANOIA
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 TRANCE PROCEDURE IS BENIGN AND REVERSIBLE BY CALM REASSURANCE
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?
ABSORPTION
Most important guideline re: hypnosis
RECORD ON VIDEOTAPE
Common experience of becoming so caught up in a movie that one ignores the environment is example of what component of hypnotic process?
ABSORPTION
Which of the following is the best use of hypnosis in a patient with chronic PTSD with severe dissociative symptoms due to childhood abuse?
LEARNING TO GAIN VOLITIONAL CONTROL OVER DISSOCIATION
In the middle phase of interpersonal psychotherapy (IPT), the therapist focuses on the patient’s: (4x)
CURRENT RELATIONSHIPS
In pt with MDD and social phobia the IPT targets social isolation by (2x):
WORKING WITH THE PT TO HELP INCREASE SOCIAL CONTACTS, STRENGTHEN THE CURRENT RELATIONSHIPS.
During the initial phase of interpersonal psychotherapy (ITP), what problem is the therapist most likely to identify for therapeutic focus with the patient (x2)?
ROLE TRANSITION
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?
“YOU FELT I WAS IMPOSING A MORAL JUDGMENT ONTO YOU, AND, APPROPRIATELY, YOU OBJECTED.”
Which interview technique is illustrated by validating a patient’s inappropriate ED visit (eg. superficial wrist laceration) but also transitioning to their emotional needs?
CONFRONTATION
Interpersonal social rhythm therapy in bipolar focuses on what?
LIFESTYLE REGULARITY
IPT of adults w/ depression begins w/assessment of pt’s adjustment to stressful life events, role transitions and disputes, and:
QUALITY OF SOCIAL CONNECTIONS
Name a treatment modality that explicitly emphasizes giving pts a formal psych Dx and assigning them sick role:
INTERPERSONAL THERAPY
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?
INTERPERSONAL THERAPY
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?
INTERPERSONAL THERAPY
Which Tx is contraindicated in initial treatment of pt experiencing domestic violence? (4x)
CONJOINT MARITAL THERAPY
What best illustrates a double bind in a family? (3x)
BETTY’S PARENTS ENCOURAGE COLLEGE, BUT COMPLAIN THAT EXPENSES WILL BE A HARDSHIP FOR THE FAMILY
Which psychosocial therapies for pts w/ schizophrenia has been shown to reduce relapse rates? (3x)
FAMILY PSYCHOEDUCATIONAL THERAPY
When conducting marital therapy with a couple who beginS to talk about divorce, what should the psychiatrist’s stance be? (2x)
FOCUS ON THE COUPLE’S RESPONSIBILITY TO DECIDE THE FUTURE OF THEIR RELATIONSHIP
What response is consistent with supportive therapy when a patient tells you their marital conflicts have resolved thanks to you the therapist?
“IM HAPPY TO HEAR THAT THINGS ARE GOING WELL AT HOME AND THAT OUR WORK TOGETHER HAS BEEN HELPFUL”
Wrap around process for youth
AN INDIVIDUALIZED, FAMILY-DRIVEN AND YOUTH-GUIDED TEAM PLANNING PROCESS
On initial psych eval, pt tells dr about recent infidelity, wants to make amends with spouse, what response would get additional info from pt?
TELL ME MORE ABOUT HOW THIS STARTED
Which of the following statements best describes the current conceptualization of family that informs family system theories and treatment approaches?
FUNCTIONING FAMILIES TEND TO HAVE CERTAIN SHARED CHARACTERISTIC ATTRIBUTES RATHER THAN COMMON STRUCTURES
Dysfunctional process in systemic therapy illustrated by mother telling 15yo son to confront his father about his excessive drinking.
TRIANGULATION
Which of the following approaches is likely to obtain the most accurate information on the factors influencing a family’s level of functioning
FAMILY COPING STRATEGIES IN RESPONSE TO PAST STRESSORS
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:
RELATIONSHIP PROBLEM
Typical phase of life problem in middle adulthood?
CARING FOR BOTH ONE’S CHILDREN AND PARENTS
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?
SEND THE PT HOME WITH PARENTS
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?
EXPLORE REASONS FOR PARENTAL DIFFERENCES
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?
OBTAIN A TEACHER REPORT
Which of the following principles is most commonly endorsed in parent management training programs for treatment of oppositional defiant disorder?
PARENTAL ATTENTION FOR PROSOCIAL BEHAVIOR
Beginning phase of therapy w child who was incest victim should first focus on what?
DEALING WITH PRIOR BETRAYAL AND ESTABLISHING TRUST WITH THE THERAPIST
5 y/o enacts fight between two dolls. What should therapist do?
DESCRIBE THE DOLL’S AFFECT WITHOUT ATTRIBUTING ANGER TO THE CHILD
Couple has sought couples’ therapy due to chronic episodic fighting. Solution focused therapist might make which intervention?
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
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?
ACKNOWLEDGING THE INTERVIEWER’S FRUSTRATION AND INQUIRING IF THE PT FEELS SIMILARLY
In cases of recovered memory, the role of the therapist is to:
DEMONSTRATE EMPATHY FOR THE PATIENT WITHOUT ENDORSEMENT OF THE MEMORY
In split treatment, the role of the prescribing psychiatrist is?
EVALUATE THE PTS NEEDS FOR MEDICATIONS WHILE MAINTAINING REGULAR CONTACT WITH THE THERAPIST
Psychotherapy research shows which of the following practices in a therapeutic relationship is most supportive for improving outcomes?
COLLECTING FEEDBACK FROM THE PT ABOUT THE TREATMENT
Pt 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?
OVERDETERMINATION
Woman is unable to achieve orgasm with her partner. Treatment = directed masturbation + ?
COUPLES THERAPY
The basis for self-psychological strategy in marital therapy is best indicated by what?
DEMONSTRATING CONFLICTS ARISING FROM EACH SPOUSE’S NEED TO HAVE HIS/HER NEEDS MET BY OTHER
Couples therapy: what is the goal of acceptance work?
EACH PARTNER TAUGHT TO UNDERSTAND OTHER’S POSITION & RELEASE STRUGGLE TO CHANGE HIM OR HER
During initial eval of an individual for couple’s therapy, it is most critical to ask about:
DOMESTIC VIOLENCE
28yo homosexual M reports being victim of domestic violence and has not reported. What is the best response for the psychiatrist to make?
LISTEN TO PT’S CONCERNS AND EXPLORE THEM
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?
“CERTAINLY, IF THAT IS YOUR WISH, BUT I’D ALSO LIKE TO SPEAK WITH YOUR PRIVATELY AT SOME POINT.”
Couples dissatisfied with each other and progressing toward divorce has which of the following?
EXPRESSION OF CONTEMPT AND STONEWALLING DURING INTERACTIONS
Couples therapy is contraindicated in which of the following situations?
UNEQUAL MOTIVATION
family psychoeducation programs for psychotic disorders reduce symptom severity and relapse risk by reversing what?
FAMILY MEMBERS EXPRESS CRITICISM, HOSTILITY AND BLAME TOWARDS THE PATIENT
This best describes the technique of reframing in family therapy:
NEGATIVELY EXPRESSED FEELING OR BEHAVIORS ARE EXPRESSED IN POSITIVE TERMS
Structural model of family therapy characterizes family as
COMPLEX SYSTEM COMPRISED OF ALLIANCES AND RIVALRIES
According to strategic and structural family therapies – underlying basis for analysis of symptoms in children, parents, and families
OBSERVABLE AND REPORTED FAMILY BEHAVIOR SEQUENCES
What is an important technique of structural family therapy?
OBSERVING THE RELATIVE INFLUENCE OF EACH FAMILY MEMBER ON THE OUTCOME OF AN ACTIVITY
Which practice is common to all couple and family therapies and contributes to a therapeutic outcome?
CONCEPTUALIZING DIFFICULTIES IN RELATIONAL TERMS
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?
ENGAGEMENT
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?
OBSERVABLE AND REPORTED FAMILY BEHAVIOR SEQUENCES
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?
TRIANGULATION
What type of family therapy uses paradoxical directives, such as prescribing the symptom or behavioral sequence?
STRATEGIC
In what type of family therapy are the concepts of family hierarchies, boundaries, coalitions, and alliances seen as core concepts?
STRUCTURAL
Contraindication to family therapy
STRONG RELIGIOUS OR CULTURE BELIEFS AGAINST OUTSIDE INTERVENTION
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:
TRIANGULATION
Pt w/ schizophrenia has recently been discharged from the hospital after a first psychotic episode. Family-oriented therapy goals should include?
EDUCATING THE FAMILY ABOUT THE PATIENT’S ILLNESS AND PROVIDING SUPPORT FOR IMMEDIATE PROBLEMS
During family meeting for 75yo pt admitted for MI, how to address family unwilling to participate in discussion?
IDENTIFY THE INABILITY OR UNWILLINGNESS TO DISCUSS AS ONE OF THE FAMILY’S PROBLEMS
According to structural family therapy, what is the indicator of normal family functioning?
WELL DEFINED BOUNDARY BETWEEN PARENTS AND CHILDREN THAT PERSEVERES AUTHORITY AND FACILITATES OPEN COMMUNICATION
In the structural model of family therapy, the family is viewed as a:
SINGLE, INTERRELATED SYSTEM WITH AN EMPHASIS ON BOUNDARIES BETWEEN THE GENERATIONS.
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:
PARADOXICAL INTENT
25 y/o single African-American man, who is a first year law student at an ivy league school, seeks psychotherapy for what he calls “academic paralysis.” He is falling behind as he spends more time brooding about the racial and socioeconomic differences between himself and his classmates. He feels comfortable with his African American psychiatrist and speaks openly about her racial slights that he experiences every day. The most important goal of dynamic psychotherapy with this pt is to: (2x)
USE THE SHARED ETHNIC BACKGROUND TO OFFER INSIGHT TO EXPLAIN HOW THE PT’S ALIENATION MAY BE ROOTED IN SOMETHING MORE THAN HIS CURRENT SITUATION
A highly motivated patient in psychodynamic psychotherapy finds that he has nothing to say, which is an example of: (2x)
RESISTANCE
This treatment goal is most specific to psychoanalytic psychotherapy: (x2)
BRINGING UNCONSCIOUS CONFLICT INTO AWARENESS
College student with good grades needs repeated reassurance. What core belief might the student have?
I CANNOT BE TRUSTED TO MAKE A GOOD DECISION
A 3 yo child has been expressing angry feelings about the arrival of a new sibling. The child has a secure attachment to parents as well as grandparents who visit frequently. During one such visit, during which the grandparents spend time holding the new baby, the child begins to bang the head rhythmically against a table. According to psychoanalytic theory, this behavior is understood as which of the following?
TURNING AGAINST THE SELF AS A DEFENSE AGAINST INTOLERABLE ANGER.
What best describes current psychoanalytic thinking about the source of countertransference phenomena in the therapist
THE THERAPISTS TOTAL EMOTIONAL REACTION TO THE PATIENT
36 y/o pt is beginning psychodynamic psychotherapy for tx of long- standing problems of inability to establish satisfying ongoing relationships. Pt expresses much skepticism that “talking about my past” will help. The most appropriate response of therapist is:
EXPLORE THE PROCESS DURING THE SESSION THAT MIGHT BE INTERFERING WITH THE ESTABLISHMENT OF THE THERAPEUTIC ALLIANCE
Which psychotherapy uses transference interpretations and clarification to develop insight and resolve conflict?
PSYCHODYNAMIC PSYCHOTHERAPY
In the context of the psychodynamic psychotherapy, the term “frame” refers to which of the following aspects of therapy?
HOW IT IS ORGANIZED IN TERMS OF BOUNDARIES AND CONSISTENT DEFINING RULES
Intensive, short-term dynamic psychotherapy is contraindicated for what condition?
ACUTE EXACERBATION OF CHRONIC SCHIZOPHRENIA
Use of meds with psychodynamic psychotherapy optimal when:
MEANINGS AND EFFECTS OF MEDS INTEGRATED INTO PT’S UNDERSTANDING
In split treatment, the role of the prescribing psychiatrist is?
EVALUATE THE PTS NEEDS FOR MEDICATIONS WHILE MAINTAINING REGULAR CONTACT WITH THE THERAPIST
Psychotherapy research shows which of the following practices in a therapeutic relationship is most supportive for improving outcomes?
COLLECTING FEEDBACK FROM THE PT ABOUT THE TREATMENT
Pt receiving weekly brief psychodynamic psychotreatment. 2 months into tx pt acknowledges being aware of maladaptive behaviors, reports now being able to remove himself from situations that frustrate him. The pt’s account is reflective of which of the following elements of brief psychodynamic psychotherapy?
DISCREPANCY
When practicing Davanloo’s short-term dynamic psychotx, one must consistently…
CLARIFY AND RELENTLESSLY CONFRONT THE PT’S DEFENSES
25 y/o F never on a date after 6 mo of psychodynamic psychotherapy. Began to struggle w/ positive feelings about M therapist that she finds hard to accept. At the same time she starts to date. Therapist believes it is transference. Therapist said nothing, he believed an interpretation might interfere w/ positive learning experience. This is example of:
A PRACTICAL/SUPPORTIVE APPROACH
Which of the following characteristics is common to all brief dynamic psychotherapies?
PRACTICAL WORKING THROUGH OF CONFLICT BY TRANSFERENCE INTERPRETATION
Determines if pt has ego strength for therapy
ASSESSMENT OF QUALITY OF RELATIONSHIPS
Goals of brief psychodynamic psychotherapy compared to long-term psychodynamic psychotherapy differ how
DISCUSSION OF TRANSFERENCE IN THE LATTER
Primary intervention in highly expressive psychotherapy:
INTERPRETATION
Psychiatrist tells pt “You told me your feelings are hurt when spouse doesn’t pay attention to you. I think you may also be saying I hurt your feelings during last session when I didn’t let you finish before ending session.” What interview technique is this?
INTERPRETATION
38 y/o pt in dynamic psychotherapy for depression says she is lesbian and is dissatisfied with her otherwise good relationship with her partner of 7 yrs b/c she wants a child and her partner does not. She thinks about leaving the relationship but this makes her feel sadness and a sense of loss. What is best intervention?
SUGGEST THAT CONJOINT THERAPY WITH THE PATIENT AND HER PARTNER MIGHT BE A PRODUCTIVE WAY TO EXPLORE THIS COMPLICATED ISSUE
32 y/o F, divorced 3 times, sees a male psychiatrist, saying she needs therapy because she is paralyzed about choosing a career. Pt has started and stopped college twice, held several waitress and clerk jobs. She hoped the therapist could tell her what job to pursue. In the initial interview she asks the therapist to send bills directly to her father, who manages her money because she has difficulty managing bills and credit cards. She explained she has to live at home to save money, but hates this because she frequently fights bitterly w her father who always wants to control her. Transference issue that therapist should expect to be central theme in therapy is:
TRY TO GET ADVICE BUT THEN BE ANGRY AT THE THERAPIST FOR GIVING IT
“Deficit model” of psychological illness in psychodynamic psychotherapy define psychopathology as:
WEAKENED OR ABSENT PSYCHIC STRUCTURES
In psychodynamic tx, interpretation of transference & resistance until insight fully integrated is called:
WORKING THROUGH
33 y/o pt in long term psychodynamic psychotherapy for several months is chronically late for sessions. Therapist suggests that this may be resistance. The pt says “oh, don’t take it personally, I am this way with everyone”. This response can be best understood as:
AN UNINTENDED CONFIRMATION OF THE PROBABLE CORE SIGNIFICANCE OF THIS BEHAVIOR.
Studies show that short-term psychodynamic psychodynamic (STPP) psychotherapy is superior to supportive therapy in the treatment of complicated grief for certain pts. Which of the following pt characteristics predicts a better response to STPP than supportive therapy?
MATURE OBJECT RELATIONS
Young female in psychodynamic psychotx admitted to seeing the resident downtown last weekend, followed him around, thinking she could later shop at the same stores and eat at same places as her greatly admired therapist. Pt not dangerous, convincingly apologized, stated that she would never repeat this behavior and hoped therapist would not “fire” her. Next step therapist should take?
INTERPRET PATIENT’S LONGING TO IDENTIFY WITH THE THERAPIST.
Pt in psychodynamic psychotherapy repeatedly asks the therapist personal questions. The therapist consistently explores the reasons for the patient’s asking, and sometimes these explorations are fruitful. Regardless, the pt persists in pressing for “real answers”. The therapist response at this point is what?
“I KNOW THIS CAN SEEM VERY FRUSTRATING, BUT THE FOCUS OF THE THERAPY SHOULD BE ON YOU”.
In context of psychodynamic psychotx, “frame” refers to what aspect of therapy?
HOW IT IS ORGANIZED IN TERMS OF BOUNDARIES AND CONSISTENT DEFINING RULES.
60 y/o successful businessman has started psychodynamic psychotherapy with a young male therapist in one early session, the pt begins by saying, “before we get started, I want to let you know about a potentially lucrative investment opportunity.” This statement is best represents:
AN ATTEMPT BY PT, PROBABLY UNCONSCIOUSLY, TO SEDUCE AND TEST THERAPIST.
“I understand why that felt ___” is an example of which type of psychodynamic psychotherapy intervention?
EMPATHIC VALIDATION
Developmental stage in psychodynamic group therapy characterized by intimacy:
WORKING GROUP
When a patient tells the clinical “I feel so lucky to have found such a wise and loving doctor” how should the physician respond
UTILIZE THE TRANSFERENCE TO STRENGTHEN THE THERAPEUTIC ALLIANCE
The following diagnostic assessment is administered with a clinical interview rather than self report
BRIEF PSYCHIATRIC RATING SCALE
32 y/o F w mixed anxiety/depression working well in supportive-expressive psychotherapy once weekly for past 3 months. Focus on issues related to childhood neglect/abuse she experienced, how these impact current relationships. In one session, silent/tearful. With encouragement from therapist, reports her 18-month- old daughter hospitalized w meningitis; she is upset, worried. Therapist listens silently. Pt leaves session early, misses next session. Following time, she is angry, accuses therapist of being uncaring/insensitive for not expressing concern about her child/empathizing w her distress. Therapist’s immediate response should be? (2x)
APOLOGIZE AND ACKNOWLEDGE THAT THE SILENCE HAD FELT HURTFUL TO THE PATIENT
Which best defines goals of supportive psychotherapy? (2x)
STABILIZE PT’S FUNCTIONING, STRENGTHEN PT DEFENSES
Patient cursed at daughter, therapist feels angry, next step
EXPRESS APPRECIATION, LOOK TO UNDERSTAND ACTION, LOOK FOR OPPORTUNITIES
Role of therapist in motivational interviewing
POINTS OUT DISCREPANCY BETWEEN BEHAVIORAL AND PERSONAL GOALS TO MOTIVATE CHANGE
What would best help a child facilitate the mourning process when a loved one dies?
A CHANGE TO EXPRESS FEELINGS OR LOSS
Pt with addiction and social anxiety talks about painful anxiety experience at AA. Statement consistent with 12 step therapy?
YOU DID THE MOST IMPORTANT THING, YOU WENT TO THE MEETING. IT WILL GET EASIER
New pt says “ you’re going to be just like the others - no doctors listen.” Best response?
“I’M SORRY YOU FELT UNHEARD IN THE PAST. CAN YOU DESCRIBE YOUR EXPERIENCE?”
Several months of weekly individual psychotx—woman w MDD, panic d/o describes repressed memories of sexual abuse by stepfather. Therapist neutral, explores pt’s experience. Pt reports increasing conviction despite sister insisting it was impossible. Plans tp get lawyer if parents do not admit & apologize. Which is best approach?
DOCUMENT CAREFULLY THE UNFOLDING PROCESS AND OBTAIN SUPERVISION
50 y/o M hospitalized for depression and melancholia. First few therapy session should focus on:
EDUCATE PATIENT ON NATURE OF ILLNESS AND TREATMENT
Which best defines goals of supportive psychotherapy?
IMPROVEMENT OF REALITY TESTING AND REESTABLISHMENT OF THE USUAL LEVEL OF FUNCTIONING
After mild MI 70 y/o seen by psychiatrist for depression. Seen for psychotherapy, given SSRI. Describes fear of imminent death. Psychiatrist tells him cardiologist is excellent, he is receiving best care. What illustrates supportive therapy:
REASSURANCE
Supportive therapy differs from psychoanalytic therapy in that the therapist who is conducting supportive therapy does what?
REINFORCES EGO DEFENSES
On the expressive-support spectrum of therapeutic interventions, which is considered the most supportive therapy intervention:
ADVISING
An important technique in supportive therapy is…
WORKING PRIMARILY IN THE PRESENT
Elderly patient begins to ask about sex, becomes hesitant. Appropriate response?
“YOU’RE DOING FINE, GO ON.”
Form of psychotherapy that would describe therapeutic goal as “improving ego functioning and self-esteem
SUPPORTIVE PSYCHOTHERAPY
Patient in treatment wants to use phone app to manage bipolar disorder. Most appropriate response?
“I WOULD LIKE TO REVIEW THE APP MYSELF. THEN WE CAN FURTHER DISCUSS THE IDEA.”
Patient presents with paranoia in the ED, he is hypervigilant and pacing, what technique would be most important to establish rapport?
ACKNOWLEDGE THE PATIENT’S FEAR
An example of “change talk” elicited in motivational interviewing
“IF I DIDN’T SMOKE, I COULD USE THE MONEY FOR MUSIC”
