TREATMENT (stages) + GOALS + INTERVENTIONS Flashcards
CLINICAL APPLICATION TREATMENT STAGES (START-MIDDLE-END) TREATMENT UNIT TREATMENT PLANNING & APPICATION > INTERVENTIONS + GOALS
[GROUP COUNSELING]
A school counselor is running a group on social skill building for high-school students. After the fourth week of one of the participants comes up to the therapist after the group to share her feelings about the group. “I am not getting anything new from this group. All of the things you are teaching us I already know,” she states.
How should the therapist respond to such disclosure?
A. Bring this issue up at the next group meeting and ask the client to think of an activity that reflects her desired level of challenge
B. Refer the client to a more advanced group and process the reason for the referral at the next group
C. Ask the client to bring this issue up at the next group meeting and process the group members’ reaction
D. Discuss the matter with this client individually and bring it up at the next group session with the rest of the group
CORRECT ANSWER = C
“Ask the client to bring this issue up at the next group meeting and process the group members’ reaction”
[RATIONALE]
C = BEST ANWER
best intervention for situation > asks CT to bring issue back to group + allows opportunity to process concerns
A = has TH bring up the issue in the group, when
the best course of action > have CT address issue
from their personal view
+
places burden of coming up with an activity onto CT
(when its TH’s responsibility to come up
w/appropriate activities)
B = is jumping the gun. It’s too soon to refer them out.
TH 1st attempt > is to remedy the situation w/in group
D = not the best answer since the convo re: this issue
should take place w/ all groups members together.
[FAMILY COUNSELING]
A therapist is meeting with a family of five. The father, Darren, is a 45-year-old African American lawyer, who has two children from his previous marriage, Aaliyah, 15-years-old and Nia, 9-years-old. The mother, Aiko, is a 38-year-old Japanese entrepreneur who also has a child from her previous marriage, a 10-year-old boy named Riku. The family states that it has been a little over a year since they moved in together and in that time the step-siblings never got along. “They fight and pick on each other all the time”, said mom, “and they compete to get our attention.” In addition, Aaliyah has been caught drinking and smoking marijuana at school. In response, her dad took away all of her privileges for an indefinite period of time. Aiko does not agree with that approach and is trying to work with him on implementing a plan where Aaliyah gets to earn her privileges back. Moreover, Riku continues to struggle with going back and forth from his mom’s house to his dad’s house. “I was so used to a certain routine”, he states, “but now I have to go over to the other house, even on days I do not want to. Plus, I forget my homework at one house or the other and it is all very annoying.”.
What factors should the therapist take into consideration in creating a treatment plan in this case?
A. Sibling Rivalry; Varying parenting styles; Visitation
plans; Maladaptive coping mechanisms
B. Sibling Rivalry; Grief and loss after divorce;
Visitation plans; Maladaptive coping mechanisms
C. Cultural differences; Different parenting styles;
Visitation plans; Maladaptive coping mechanisms
D. Sibling Rivalry; Different parenting styles; Visitation
plans; Development of new relationships in the
family
CORRECT ANSWER = A
“A. Sibling Rivalry; Varying parenting styles; Visitation
plans; Maladaptive coping mechanisms”
A = covers all of the issues affecting the family that are clearly mentioned in the vignette
[RATIONALE]
B = has the grief & loss part in it which ISN’T part of stem
C = mentions cultural differences & although it’s noted in the stem > ITS NOT AN ISSUE THE FAMILY discusses
D = lists dev of new relationships > NOT ISSUE IN STEM
[case conceptualization]
A 5-yr-old child is brought to therapy by his parents. The parents state that their son is in kindergarten and 3 months into school he still refuses to let go of them at drop-off and cries for part of the morning once they leave. He engages minimally with other students and is not meeting all of the established academic milestones.
Which of the following goals should the therapist include in the treatment plan for this case?
A. Increase the child’s self-soothing skills;
Improve the child’s relationship with his classmates;
Decrease child’s reliance on parents for emotional
stability
B. Increase the child’s self-soothing skills;
Improve the child’s relationship w/his classmates &
teacher;
Explore underlying causes of the child’s reactive
attachment style
C. Decrease emotional reactivity in classroom setting;
Increase the child’s ability to tolerate time away from
parents;
Improve communication between the child and his
teacher
D. Decrease emotional reactivity in classroom setting;
Increase the child’s ability to tolerate time away from
parents;
Improve academic performance
When it comes to questions regarding case conceptualization and treatment planning, we want to find answers that link back to what was noted in the vignette.
CORRECT ANSWER = A
“Increase the child’s self-soothing skills;
Improve the child’s relationship with his classmates;
Decrease child’s reliance on parents for emotional
stability”
All parts of answer A are strong. They directly address issues mentioned in the vignette–difficulty calming down when parents leave, minimal interactions with classmates, and excessive need for parents.
[RATIONALE]
B = includes exploration of reactive attachment style, which is not indicated in the vignette
C = include a focus on emotional reactivity, which isn’t a concern in the vignette
D = include a focus on emotional reactivity, which isn’t a concern in the vignette
What is the main objective for the MIDDLE stage of TX?
The main objective of middle stage TX is to =
“ elicit change in the client’s presenting problem.”
Therefore, whether a question is more generally asking about middle stage interventions or those that are theory-specific, you must
= prioritize answers that help CT achieve his/her TX goals
A 46-yr-old man who emigrated from Ecuador eight years earlier has been in therapy for several months to address symptoms of anxiety and difficulties with sleep. During the first month of treatment, the therapist developed a good rapport with the client and collaboratively identified goals for treatment. The client’s chief complaint is that he is up most evenings with his mind racing about finances, and his family that is still in Ecuador, including his inability to care for his aging parents who are so far away. The client shares that due to the lack of sleep he has been exhausted at work and is constantly scared he is going to lose his job.
Which of the following actions would a Cognitive Behavioral Therapist utilize in the middle stage of treatment?
A. Practice diaphragmatic breathing in sessions w/the CT and discuss how he can integrate these skills into his daily routine to decrease anxiety levels.
B. Utilize an automatic thought record on a daily basis to better understand cognitive distortions and develop healthier alternative thoughts.
C. Ask the CT to identify times when his anxiety did not interfere with his sleep and compliment his ability to use successful techniques.
D. Educate the CT about the different cognitive distortions and collaboratively identify those he is employing that cause his anxiety and sleep disorder.
CORRECT ANSWER = B
“Utilize an automatic thought record on a daily basis to better understand cognitive distortions and develop healthier alternative thoughts.”
B = best option available. The CT would have learned how to use an automatic thought record at the onset of TX, and would continue to utilize it through the middle stage of TX.
This intervention addresses the CT’s chief complaint + it’s strongly linked to CBT + would be used in the middle TX stage.
There are three parts to the question being asked (actions, CBT, and middle stage) and this is the only answer option that correctly addresses all of them.
[RATIONALE]
A = is something a CBT TH would do & it’s an
appropriate intervention to use based on the
presenting issue > but this would be more suitable to
earlier stages of TX. (Remember, by the middle stage
of TX we’ve already laid the foundation for making
change happen & have already identified ways for
CT to integrate relaxation techniques into his daily
routine.)
C = Similar to (A) & (D), this intervention would properly
address CT’s anxiety > but it’s more closely
associated with Solution Focused therapy, not CBT.
D = this is an intervention that would be used by a CBT
TH and it makes sense based on info in the vignette >
However, by the middle TX stage, the CT should
already have an understanding of cognitive
distortions.
[ASSESSMENT]
A 50-yr-old male client meets with a therapist on the advice of his husband. The client shares that he has been out of work for almost a year, losing his job after his company completed mass layoffs. He reports feeling discouraged by his job prospects, feels lost without a place to go each day, and feels increasing hopelessness with each passing month he is unemployed. He states, “I feel completely useless and am questioning the point of it all. I feel completely dependent on my husband and I know he’s sick of being the sole breadwinner.”
Which of the following actions should the therapist take to assess this client?
A. Explore job history, identify existence of somatic concerns, identify familial coping patterns
B. Explore job history, determine current risk of self-harm, explore support systems
C. Explore mental health history, identify existence of somatic concerns, explore coping mechanisms
D. Explore mental health history, determine current risk of self-harm, explore coping mechanisms
CORRECT ANSWER = D
“Explore mental health history, determine current risk of self-harm, explore coping mechanisms”
=
This question provides information that should raise a red flag regarding the CT’s safety and influence the THs priorities for assessment.
First, the CT reports he is feeling hopeless & helpless, and makes the alarming statement, “I feel completely useless and am questioning the point of it all.”
The question is asking which actions the TH should take to assess this CT. With this type of question, it’s possible several answer options include items we would want to assess, but > we need to prioritize what is most important in this case. We’ve noted that the CT’s expressions of hopelessness and helplessness should raise red flags regarding danger to self.
**CT is expressing thoughts and feelings that are indicators of potential suicidality. CT safety is our priority & we must immediately assess for risk of self harm.
**If an answer does not include a focus on the CT’s risk of self-harm or suicidality, we can eliminate it.
A strong consideration when assessing risk is =
CT’s prior mental health + CT’s coping mechanisms
These help TH better understand =
– CT’s level of risk based on prior mental health
AND
– help TH identify strategies to manage safety
[RATIONALE]
A = RULED OUT > does not assess self-harm or suicide
B = While there’s nothing inherently wrong with (B) > the
CT’s job history isn’t as important a factor to consider
(making it the weaker answer between B and D)
C = RULED OUT > does not assess self-harm or suicide
[WORKING WITH CHILDREN & ADOLESCENTS]
A 15-year-old high school student is referred for individual therapy by his school counselor. The mother and father attend the first session with their son and consent to treatment. The parents dominate the session and express concern that their son suddenly appears to be struggling with severe anxiety. They tell the therapist that he was extremely active in sports and excelled in school, but recently his anxiety has caused him to drop off the basketball team and his grades have dropped. After four sessions, the client opens up and shares that he believes the anxiety is a result of all the pressure his parents place on him. The mother contacts the therapist and asks for a comprehensive update regarding her son’s progress.
Which of the following actions should the therapist take in response to this request?
A. Inform the mother that the therapist is not able to discuss the client’s progress without his permission.
B. Provide the mother with a comprehensive update regarding the son’s progress since the parents consented to treatment.
C. Discuss the mother’s request with the client and determine what information he would like the therapist to share and request a release of information.
D. Determine what information can and cannot be shared with the parents based on the therapist’s understanding of implications to therapeutic relationship.
CORRECT ANSWER = C
“Discuss the mother’s request with the client and determine what information he would like the therapist to share and request a release of information.”
= strongest answer choice provided > we directly address the request with the client and allow him to make the decision of what to share.
We would then need a release of information to determine what information can be shared by the Therapist with the parents.
[RATIONALE]
When working with minors, it’s important to separate consent from confidentiality. In this question, the minor is old enough to consent to treatment and therefore can determine what information can be shared with his parents.
A = Is a tempting answer b/c the TH is properly telling the
mother that info can’t be shared > BUT We would
need a release from the minor, not just his permission, before we can have this conversation
B = knocked out quickly > We can’t provide the comprehensive update just b/c parents consented to TX. Remember, consent and confidentiality are two separate issues and should not be confused.
D = incorrect b/c it indicates the TH is determining what may or may not be shared with the parents. This would be a stronger answer if the minor were under age 12.
**However, since the boy is old enough to consent to his own treatment, he gets to make this determination.
PSYCHOTIC DO …TX PLANNING
1st = always stabilize symptoms (if actively psychotic)
> Once ct is stabilized > respond to needs of ct
PSYCHOTIC D/O
Ct actively hearing voices > TH find out content of voices
Non-crisis voices > speak to psychiatrist
If voices tell ct to do harm to self or others > ct is gravely disabled = initate 5150
Social skills group = great resource
Depressive/Bipolar Related Disorders
TREATMENT PLANNING
BIPolar 1 > medication necessary (discuss medication as tx option)
Treatment planning
***Goals = 1st stabilize SX + pre-morbid functioning
\+ Develop additional coping skills \+ awareness of triggers \+ self-soothing techniques \+ access supports (refer to group; work w/family)
MOTIVATIONAL INTERVIEWING is focused on _____
MOTIVATIONAL INTERVIEWING is focused on…
= resoling ambivalence using Cts values/concerns to elicit change
MOTIVATIONAL INTERVIEWING is rooted in what theory
MOTIVATIONAL INTERVIEWING is rooted in ….
= CT-centered
The main principles of MOTIVATIONAL INTERVIEWING ARE….
• Express Empathy (see world as CT sees it)
• Develop Discrepancy (mismatch btwn cts expressed
values & their behaviors)
•Rolling with Resistance (dont challenge, argue, or use
fear)
• Support Self-Efficacy (recognize/highlight CT strengths + elicit hope/capacity for change)
MOTIVATIONAL INTERVIEWING interventions (OARS)
Motivational Interviewing INterventions (OARS)
- Open-ended questions
- Affirmations
- Reflecting
- Summarizing
