Question 1

Mark is 20 years old. He is engaging in therapy because he has always had an interest in psychology and wants to examine how he could benefit. As a therapist, you might begin with Mark by talking about:

Accepted Answer

While he has a strong interest, he has yet to really identify any goals for therapy. While it is always helpful to have someone who sees the importance and need for therapy, it is even more important as his therapist to have a direction, since he may be looking to see where you will take his treatment. Then again, you'll want to watch for the client's ability to participate in his own treatment planning and include him at every opportunity.

Question 2

When a client is showing very little insight into his or her problem behaviors, it demonstrates that he or she would be a great candidate for:

Accepted Answer

Of all the options available, CBT is the one that would take the least amount of insight to accomplish goals and has a very prescriptive nature, by which problems are solved and eliminated without necessarily needing to touch on emotional regulation or understand emotional connectedness. CBT is also likely to demonstrate the highest level of efficacy in the shortest interval.

Question 3

Which of the following could be defined as a crisis?

Accepted Answer

A crisis could be defined as any situation that involves acute stress. That is to say, stress that lasts for a brief period of time, but has a much more concentrated effect on the systems involved. Being late with rent is a crisis since it puts people at risk for losing their housing. Being the victim of an assault would require immediate medical attention and witnessing a crime puts individuals at risk for PTSD or in danger for fear of retribution. All of these have immediate, stressful consequences.

Question 4

While we might know how to see a crisis coming or recognize it when it's active, what happens to our clients, the individuals who were involved, witnessed, or heard about the crisis?

Accepted Answer

The nature of a crisis is that clients lose their ability to cope as they know it or attempt to apply current coping skills without any success. Both of these situations result in decompensation that can present clients very readily to therapy, whether or not they are prepared. While they are overwhelmed, oftentimes in crisis, they push those feelings away in favor of something that looks and feels more normal, even if it is only temporary.

Question 5

As part of Roberts' Seven Stage Crisis Intervention Model, at what point during an incident would it be appropriate to examine feelings?

Accepted Answer

You cannot well examine feelings until you identify who was involved and complete an assessment. You would need to identify participants prior to ascertaining from them the dimension of the problem and generating any alternatives to those plans. Feelings could range from anger and fear to hopelessness and despair. It is especially important to be prepared for every type of feeling that could be associated with crisis situations.

Question 6

John and Julie come to see you for therapy. They are a nice couple, mid-thirties, have one son. But now, they are finding that they do not feel they know each other all that well. As a Gottman therapist, you might suggest:

Accepted Answer

Much like behavioral therapy's concept of reciprocity, where one person does for the other, the couple puts together a map of what would help them in feeling most appreciated from one another and give specific examples of potential outcomes that would indicate increased happiness. Such direct explanation increased communication and problem-solving skills between the couple.

Question 7

Again, using your Gottmann training, you are working with a couple who is having a hard time seeing anything but the negative. You bring out the idea that the couple engage in:

Accepted Answer

While it seems like a given that anyone would understand, many couples have a hard time grasping that their love and admiration go further than their strife and their pain. It is true and while skill building is important, nothing matches the importance of feeling appreciated. Reactionary feelings and apathy are especially contrary to relationship building.

Question 8

If you are a Gottman therapist, what kind of dreams are couples encouraged to discuss in your office?

Accepted Answer

While all of the marital strife can make it into the room all by itself, clients likely need help when determining which dreams they need supported. Individuals are likely more drawn to those things that create conflict rather than those things that provide a good deal of comfort. The therapist can provide quite a bit of help regarding the content of dreams that need to be brought to the forefront to be achieved by the couple. Having common goals can also increase teamwork.

Question 9

You use a lot of psychodynamic theory in your practice. When you hear your client talk about his work in a positive light one week and a negative light the next, you feel as if you need to bring it up to him. You decide to use confrontation. In confrontation, the role of the therapist is:

Accepted Answer

Contrary to popular definition, psychodynamic therapists only use confrontation to point out the discrepancies in the stories. They do not make a comment as to whether or not it means anything or why the client may have made such comments. Those specifics are not important. Instead, the client's own recognition is key if psychodynamic theory is at work to bring things into the conscious mind.

Question 10

As a psychodynamic therapist, you are having a difficult time with someone who is showing features of narcissistic personality disorder. This is because, in your terms, the person is more accurately portraying:

Accepted Answer

Distortion refers to the psychodynamic defense mechanism by which a person presents an alternate reality that they are a part of and are clearly more comfortable with than one in which they experience pain, denial, and refusal. In alternatively created realities, clients are able to experience a different sense of equilibrium, even if not present to others.

Question 11

You are seeing parents who do not believe in the negative effects of punishment. They define punishment as the removal of things in order to get what they want. After doing some structural work to help them understand the systemic hierarchy, you then give them a lesson in response cost, which is:

Accepted Answer

Response cost can be defined as the cost associated with a negative response. These response costs can include loss of goods, services, privileges, and relationships. Imitation of proper authorities comes from shaping, while minimizing cost to others is a very selfless prospect. Once you have responded to unmet needs, they are no longer unmet and the response is most likely a favorable one for the individual, leaving them without a cost.

Question 12

A blended family presents in your office for help with their son, Eric. Ever since mom was remarried, Eric has been unable or unwilling to connect with his stepdad. When discussing how to proceed with treatment, you identify that Eric may be dealing with:

Accepted Answer

Conflicting loyalties are common in kids who are affected by divorce or remarried families. "Who do I trust?" "Who is thinking about me?" are the critical questions that so many ask. They may exhibit any of the other symptoms, but if the conflict appears to have stemmed from the divorce or remarriage, often times it can be traced to conflicting loyalties on the part of the child.

Question 13

A family that you had seen for a year returns to you for an appointment after six months without therapy. They are reporting that while the individuals in the family made a change and it seemed to work, that they actually needed something else. They couldn't see the family getting any closer or having any major changes. What they are seeking is:

Accepted Answer

All of what the family was able to describe was success with first order change. The individuals within the system were able to change in the best possible ways. They are beginning to achieve goals that they set for themselves personally, but the family structure is no longer able to support their growth, since the system did not adapt when the individuals did. As a result, the family is in need of second order change to deal with changing personal patterns, to make them more adaptable within the family.

Question 14

As a Gestalt therapist, how could your controlled involvement benefit the client?

Accepted Answer

Controlling involvement as a therapist is critical, so as to avoid the appearance or actual gain from any client while they are in your care. Reminding yourself that this treatment is for the benefit of the client can be helpful here. All of the other options here could result in crossing the line into situations that are not healthy and could be viewed as overall unsustainable.

Question 15

As a narrative therapist, you find that your client is unwilling to accept the reality of her situation, but is even more unwilling to explain it to you. When a client believes that we as therapists know too much, which of the following narrative interventions can be helpful?

Accepted Answer

If you are having difficulty getting your client to elaborate on certain issues, the client may believe that you already know what they will say and so has a hard time elaborating on what issues you want to hear about. Playing dumb, or deliberate ignorance, can be most helpful when trying to gain new information in the clients' words and not add anything that you might assume or have ruled out from their own words.

Question 16

When clients are having a very difficult time articulating what is going on for them, which of the following narrative techniques is designed to make it easier for them?

Accepted Answer

Externalizing conversation is just that-a conversation that allows the client to externalize whatever feeling or situation is bothering him or her. You are able to take the issue and move it outside of you, talk to it, address it, and confront it. This is much like the Gestalt technique of the empty chair, but is used with situations instead of people. In fact, clients need to work very hard not to re-internalize the conversation once it is happening and narrative therapists should be on the lookout for any sudden changes in language that might indicate this.

Question 17

When you have exhausted many of the conventional methods for addressing PTSD, you decide that it might be worthwhile to examine being trained in which of the following methods?

Accepted Answer

EMDR, or Eye Movement Desensitization and Reprocessing, requires quite a bit of training, but has been known to work for clients who have exhausted other conventional methods of treatment when addressing PTSD. Eye movements are used to help the client focus on stationary objects while reliving some of the trauma in the present moment, so as to promote safety and increased ability to cope.

Question 18

In order to give the client more power in determining what the situation looks like, the Adlerian-trained therapist can:

Accepted Answer

Using phrases like "I wonder if . . ." or "It sounds to me like . . ." or "Is what you're saying . . ." allows the client to offer their own explanations and not have the therapist make the mistake of inserting his own assumptions. While it helps to have a therapist who can end on time and remain neutral, this is not something that always pertains to your situation developing within therapy. And when it comes to offering advice, most therapists have a difficult time offering advice, particularly Adlerian, since it takes away some of the client's own initiative.

Question 19

You see couples and families in your practice. You just finished an appointment with a couple who decided to put their child on a contingency contract. You see a couple now who could benefit from the same treatment. How do you approach it?

Accepted Answer

The idea behind contingencies is "If you do this, then I will do that" or "If you do this, then you will be able to do that." It works with anyone, regardless of the person's age or state in life. Every human is externally motivated, although the motivating factors may change.

Question 20

When examining patient records for the potential to do excellent work, you see that the patient has some depressive symptoms. The most notable symptom is:

Accepted Answer

Willingness to change and clarity of thought are not especially symptoms of especially depressed persons. Rather, weight differentials and anhedonia are significant as they relate to depression. Anhedonia is the most notable symptom, since it is defined to include loss of pleasure, interest, and depth in any number of subjects, but most primarily those that were a source of enjoyment before the onset of depressive symptoms.

Quiz 5: Treatment