EPPP - Clinical Psychology Domain Quiz

B

Sue and Sue's model distinguishes between four worldviews that reflect varying combinations of internal and external locus of control and locus of responsibility. Sue and Sue note that mainstream American culture "can be described as the epitome of the individual-centered approach that emphasizes uniqueness, independence, and self-reliance" (p. 277). These qualities reflect an internal locus of control and an internal locus of responsibility (IC-IR).

Answers A, C, and D: Sue and Sue proposed that members of a racial minority group are more likely to exhibit an internal locus of control and external locus of responsibility (IC-ER) as they have become more aware of their own racial and cultural identity and the impact of oppression on their lives. Caucasian therapists are said to most often embody an IC-IR worldview and are noted as having the greatest difficulty when working with members of a racial minority group who have an IC-ER worldview.

C

Nancy Boyd-Franklin discusses this area of research in her book Black Families in Therapy: A Multisystems Approach, New York, Guilford Press, 1989. Boyd-Franklin found that the structure of the African American middle-class family often reflected equal sharing of power by the spouses as well as more permeable boundaries in general. For example, these families were open to influences from the extended family and the African American community.

B

While Herek acknowledged that sexual prejudice does not always accurately predict specific behaviors, he did note trends in this area. Specifically, Herek (2004) indicated that individuals who identify as heterosexual and have high levels of sexual prejudice are more likely than those with low levels of sexual prejudice to "respond negatively to gay individuals, support anti-gay political candidates and policies, and discriminate against gay people" (p. 19).

Answers A and D: According to Herek, individuals with a low level of sexual prejudice are less likely to engage in discriminatory actions against those who identify as gay.

Answer C: Although the retiree is older and identified as having a high level of sexual prejudice, his sexual orientation is not identified. Thus, this is not the best answer. According to Herek, a high level of sexual prejudice in an individual who is heterosexual correlates with an increased likelihood of discrimination against those who are gay.

D

A survey of psychotherapists conducted in the early 1980s indicated that therapists expect their work to be stressful but also expect that their efforts will be appreciated and have positive results. The overwhelming majority of respondents (73.7%) said the major source of stress in their work was the lack of therapeutic success.

Answer A: In their survey of therapists, B. A. Farber and L. J. Helfetz (The process and dimensions of burnout in psychotherapists, Professional Psychology, 13(2), 293-301, 1982) found that isolation was cited by only 11.1% of their respondents as a major source of stress.

Answer B: Only 22.2% of respondents said that overwork was a major problem.

Answer C: About 13% of respondents cited this as a source of stress.

C

D

Organizational policies (answer A) and professional knowledge (answer B) make up the base of the triangular model, while the supervisory relationship (answer C) is at the core, however, the primary emphasis is on providing service to the clients.

B

According to APA guidelines on telepsychology, psychologists must protect patient information stored or streamed on devices. Using an unencrypted system increases the risk of exposing patient information.

D

While this would likely prove to be invaluable, the APA guidelines for clinical supervision do not list this as an essential component of training in supervision. The guidelines rather indicate that formal education and training in supervision should include instruction in didactic seminars, continuing education, or supervised supervision.

C

Functional analysis entails examination of the purpose of behavior with the assumption that behavior cannot be understood in isolation.

Answer A: Functional analysis is a behavioral model based on stimulus-response learning mechanisms.

Answer B: Functional analysis focuses on behavior rather than cognitions.

Answer D: The concept of acceptance and mindfulness are unrelated to functional analysis.

B

Yalom's 11 curative factors include altruism, cohesion, universality, interpersonal learning input and output, guidance, catharsis, identification, family re-enactment, self-understanding, instillation of hope, and existential factors.

Answer A, C and D: Interpersonal insight is the only term listed that is not one of Yalom's curative factors.

C

Experts have noted that the group leader's role may be impacted by collective projective processes or the shared transferences of participants. This has the potential to result in non-therapeutic countertransference enactments. The leader's ability to manage these internal reactions and respond therapeutically is related to positive treatment outcomes.

Answer A: Role reversal is a technique that is at times used in psychodrama. It involves having two individuals exchange roles for the purpose of working through an interpersonal issue.

Answer B: Multiple transferences occur within group therapy as group members experience transference towards the therapist, between one another, and collectively.

Answer D: In group therapy, acting out occurs when a group member indirectly expresses a thought, feeling, or desire behaviorally rather than verbally.

B.

According to Helms, her White Racial Identity Development Model proposes that identity development involves two phases: abandoning racism (statuses 1-3) and developing a nonracist White identity (statuses 4-6). Each status is characterized by a different information-processing strategy (IPS), which refers to the methods the individual uses to reduce discomfort related to racial issues.

Answer A: The original version of Cross’s (1971) Black Racial (Nigrescence) Identity Development Model described identity development as involving a shift from Black self-hatred to Black self-acceptance and consisted of five stages.

Answer C: The Racial/Cultural Identity Development Model distinguishes between five stages that people experience as they attempt to understand themselves in terms of their own culture, the dominant culture, and the oppressive relationship between the two cultures. Each stage reflects changes in how the person views the self, others of the same racial/cultural group, members of other racial/cultural groups, and members of the dominant group.

Answer D: This is a combination of a phase from the original version of Cross’s Black Racial Identity Development Model (self-hatred) and Helms White Racial Identity Development Model (abandoning racism).

C

Several other identity development models have been developed for LGBT individuals. Like Troiden’s model, most describe the first stage as involving an initial awareness may include questioning one’s sexual orientation. For example, based on a review of the existing models, Sophie (1985/86) developed a general stage theory of lesbian identity development that consists of four stages: first awareness, testing and exploration, identity acceptance, and identity integration.

Answer A: During this stage, the individual becomes more certain of his/her homosexuality and may deal with this realization in a variety of ways – e.g., by trying to “pass” as heterosexual, by aligning him/herself with the homosexual community, or by acting in ways consistent with society’s stereotypes about homosexuality. 

Answer B: During this stage, at the onset of puberty, the individual realizes that he/she is attracted to people of the same sex and attributes those feelings to homosexuality, which leads to turmoil and confusion.

Answer D: During this stage, which is usually characteristic of middle childhood, the individual feels different from his/her peers.

C

An etic approach is based on the assumption that universal principles apply across cultures. An emic approach is based on the awareness that cultures vary and, consequently, cannot always be understood from the perspective of universal principles. In other words, the etic approach is universalistic, while an emic approach is relativistic.

C

Berry (1987) and his colleagues identified four classifications of acculturation status including integration, assimilation, separation, and marginalization. A person is classified in the marginalization status when he/she does not identify with either culture.

Answer A: A member of a racial/cultural minority group who adopts the values, attitudes, and customs of his/her own minority culture but withdraws from the dominant culture is labeled as separated.

Answer B: This term is not associated with Berry's model.

Answer D: According to Wrenn (1985) culturally encapsulated clinicians interpret reality via their own biased cultural lens and disregard both their own bias and existing cultural differences.

A

According to Helms, a parallel interaction occurs when the therapist and client have the same or similar levels of racial/cultural identity. Although parallel interactions can produce mutual understanding and respect, they can also lead to inertia, especially when the therapist and client are at less advanced stages of identity development.

Answer B: Helms referred to this as a regressive interaction.

Answer C: Helms referred to this as a progressive interaction.

Answer D: Helms referred to this as a crossed interaction.

A

The four response options consist of Berry's categories of acculturation. Fouka (2019) conducted a study that concluded that when faced with increased discrimination, Germans often increased their efforts to assimilate (ex. by Americanizing their names). Assimilation is Berry's second acculturation status. Those in this status accept the majority culture while relinquishing their own culture.

Answer B: Integration involves maintaining your own culture while incorporating aspects of the dominant culture. German immigrants in Fouka's study were described as engaging in greater assimilation in conjunction with discrimination rather than integration.

Answer C: According to Fouka the opposite (assimilation) is true.

Answer D: Marginalization involves a rejection of both one's own culture and the dominant culture. Fouka indicated that the immigrants in her study engaged in assimilation as a method of countering discrimination rather than marginalization.

B

According to David & Okazaki (2006) colonial mentality is a "form of internalized oppression in which the colonized culture and society are considered inferior to the culture and society of the colonizer." Recent studies have found that colonial mentality is a determinant of depression symptoms among Puerto Rican, Filipino, and Ghanaian adults.

Answer A: The opposite is true.

Answer C: By definition, a colonial mentality views the colonized population's culture as inferior.

Answer D: The opposite is true. Colonial mentalities represent an internalization of the colonized society and culture as inferior while the colonizer and his/her culture is believed to be superior.

A

Ridley (1984) notes that distrust of White mental health professionals by members of ethnic minority groups is related to the fact that professionals often misinterpret a healthy, adaptive response to racism (cultural paranoia) as pathology (functional paranoia).

Answer B: The opposite is true. Cultural paranoia is a healthy reaction.

Answer C: This is not true. Cultural paranoia is experienced towards the dominant race.

Answer D: Disclosure flexibility is the ability to recognize when self-disclose is or is not appropriate. Cultural paranoia is not an example of disclosure flexibility.

C

The term historical trauma was coined by Maria Yellow Horse Braveheart in the 1980s. It is defined as "cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma experiences" (Braveheart, 2003).

Answer A: Historical trauma emanates from collective rather than individual trauma.

Answer B: This is not true. Historical trauma specifically relates to the manifestation of trauma among oppressed populations who have experienced collective harm.

Answer D: Historical trauma is not the result of colonial mentality. However, colonial mentality often manifests among populations that have experienced historical trauma.

A

Cultural humility advocates that therapists commit to lifelong learning which entails self-examination and self-awareness.

Answers B, C, and D: Mosher, Hook, Captari, Davis, Deblaere, & Owen (2017) proposed a four-part framework for integrating cultural humility in therapy which includes: engaging in critical self-examination and self-awareness, building the therapeutic alliance, repairing cultural ruptures, and navigating value differences.

B

The APA guidelines for the practice of telepsychology were published in 2013 and address issues related to the practice of telepsychology. Although a client’s gender identity may inform psychological practice, the guidelines do not specify unique considerations for telepsychology.

Answer A: The APA guidelines for the practice of telepsychology state that as part of informed consent, psychologists discuss with their clients with billing documentation will include before the onset of services. Billing documentation may include the type of telepsychology used, the type of telecommunication technology used, and any fee reduction for technology failures.

Answer C: The guidelines state that psychologists who utilize telepsychology demonstrate both competence with the technology used to provide services and the potential impact of the technology on clients, supervisees, and other professionals.

Answer D: The guidelines specify that psychologists seek to obtain informed consent “that specifically addresses the unique concerns related to the telepsychology services they provide” (APA, 2013).

B

Secondary prevention aims to reduce the impact of a disorder that has already occurred. In this case, secondary prevention helps to identify individuals with a problem and to decrease the impact of the problem. Students that indicate they are engaging in excessive drinking are receiving a secondary intervention to reduce the severity and duration of their disorder. It is well-versed in the literature that screening tools aimed to identify individuals for treatment are secondary interventions.  The question is asking about the level of intervention for students at the individual level. Secondary interventions are implemented at the individual level.

Answer A: Primary prevention aims to reduce the prevalence of mental and physical disorders. In this case, primary preventions would aim to reduce the number of students who engage in excessive drinking before they ever start drinking. Primary prevention is typically conducted at the group level, so a primary prevention in that case would be classroom presentations aimed at increasing awareness of the risks of excessive drinking to decrease the number of students who drink.

Answer C: Tertiary interventions are designed to reduce the duration and consequence of mental and physical disorders, rather than decreasing the prevalence of disorders. Rehabilitation programs and support groups are examples of tertiary interventions. 

Answer D: Relapse prevention is not a type of community psychology intervention. Relapse typically refers to resumption of substance use after a period of abstinence, although the term may also refer more broadly to the worsening of mental health symptoms after a period of remittance. Relapse prevention is designed to help individuals utilize active coping skills to prevent a return to substance use or a worsening of mental health symptoms.

A

Cultural competence requires awareness of transference reactions that relate to or are impacted to some degree by race; however, general transference reactions are not inherently considered a part of cultural competence.

D

Strategic family therapy, developed by Jay Haley, considers the first session of therapy to be an important determinant of the course of therapy, and the first session involves four stages. In the social stage, the therapist observes the interactions of family members and encourages the involvement of all members. In the problem stage, the therapist gathers information about what brought the family to therapy. In the interaction stage, the therapist observes the family members discussing the identified problem. In the goal-setting stage, the therapist and family members agree on a contract that defines the goals for therapy. 

Answer A: Structural family therapy, developed by Salvador Minuchin, posits that all families have an implicit structure that determines how family members relate to each other. Therapy techniques joining, evaluating the family structure, and restructuring the family. 

Answer B: Functional family therapy, developed by James Alexander, has a clinical practice model with three distinct phases: engagement and motivation, behavior change, and generalization. 

Answer C: Extended family systems therapy, developed by Murray Bowen, describes the functioning of family members in terms of differentiation of self, emotional triangles, and the family projection process. This therapy usually includes only two family members so the therapist can become the third member in the therapeutic triangle.

C

The assumptions and procedures of motivational interviewing were derived from Rogers' client-centered therapy and Bandura's notion of self-efficacy. With regard to client-centered therapy, motivational interviewing stresses therapist empathy, reflective listening, and responding to client resistance in a nonconfrontational manner.

Answer A: MI was first used as a treatment for alcohol addiction but has since been applied to other problems including cigarette smoking, eating disorders, diabetes, and pain management.

Answer B: MI addresses self-responsibility in that it is centered around a client's own motivation to change. It is client-centered in nature; thus, the therapist-client relationship is key.

Answer D: MI is non-confrontational in nature, and thus positively reframes resistance.

C

Prochaska and DiClemente (1992) distinguish between six stages in the change process. These include the four listed in the responses plus maintenance and termination stages. In the preparation stage, the person has a clear intent to take action in the near future.

Answer A: During this stage, the individual has little insight into the need for change.

Answer B: In the contemplation stage, the person is aware of the need for change and is considering change but has not yet committed to it.

Answer D: In the action stage, the person actually takes steps to bring about change. (In the maintenance stage, he/she consolidates the change and takes steps to prevent relapse.)

A

The research on ethnic matching is far from consistent. However, most studies have found that it has a greater impact on premature termination from therapy than on its outcomes. Members of some groups are more likely than others to benefit from client-therapist matching in terms of ethnicity. When there are benefits, however, they are usually (but not always) for dropout rates rather than for therapy effectiveness.

Answer B: The opposite is true.

Answers C and D: Research suggests that therapist matching impacts treatment length.

D

The key phrase in this question is "during the first session." According to Walker, a leading advocate of feminist therapy, a primary goal during the crisis intervention (first) phase of therapy is to help the abused woman rehearse an escape plan (Feminist therapy with victims/survivors of interpersonal violence, in L. B. Rosewater and L. E. A. Walker (Eds.), Handbook of feminist therapy, 1985).

Answer A: Although helping female clients recognize the impact of oppressive social and political forces on their attitudes and behaviors is an important part of feminist therapy, it would probably not be the first step in therapy when the presenting problem is spousal abuse.

Answer B: Feminist therapists would not inappropriately place the burden of responsibility on the woman when addressing abuse.

Answer C: A feminist therapist would not be likely to "insist" that a woman go to a shelter, although this would probably be discussed as an option

B

For many therapists, it is common practice to combine individual and group therapy. However, there may be some drawbacks to this approach. Yalom (1975) and others caution that individual therapy can "drain off" clinical material from group therapy and thereby decrease involvement and participation in group therapy.

Answer A: Several authors suggest that concurrent individual and group therapy is the best approach for these clients (see, e.g., The psychiatric therapies, American Psychiatric Association, 1984).

Answer C: At least one authority (Anthony, et al., 1971) suggests that the opposite is true: Group therapy can actually reduce resistance in individual therapy.

Answer D: It is not true that concurrent group and individual therapies are beneficial only when they are provided by different therapists.

A

Unlike consultants, supervisors have administrative responsibility for and are in a position of power over the supervised.

Answer B: Theme interference is a type of transference that occurs when a past unresolved conflict related to a particular type of client or circumstance is evoked by and interferes with the consultee's current situation. This concept does not distinguish supervision from a consultation.

Answer C: Mentorship is distinct from both supervision and consultation.

Answer D: This is not the best answer as a parallel process may or may not occur during the supervision process.

A

Sue and Zane note that gift-giving is a common ritual in Asian cultures and propose that it has beneficial effects on the involvement and motivation of Asian and non-Asian therapy clients, especially when it occurs during initial therapy sessions. Waiving a late fee would not be considered gift-giving as defined by Sue and Zane given that doing so does not directly advance the client's treatment goals.

Answer B: Normalizing a client's problems is one example of gift-giving described by Sue and Zane.

Answer C: Sue and Zane also listed collaboratively setting treatment goals as an example of gift-giving.

Answer D: Facilitating the acquisition of a new skill would also be an example of Sue and Zane's concept of gift-giving.

A

Sue and Zane indicated that gift-giving has beneficial effects on the involvement and motivation of Asian and non-Asian therapy clients.

Answer B: The opposite is true.

Answer C: Sue and Zane proposed that it had beneficial effects.

Answer D: While Sue and Zane proposed that gift-giving has beneficial therapeutic effects, the researchers did not specifically indicate that it reduces symptoms.

C

Past research suggests that therapy with African American families is usually most effective when it takes into account social, political, socioeconomic, and other contextual factors. Thus, a multisystems (ecostructural) approach has been recommended by several experts for therapists working with African American families (e.g., Aponte, 1994; Boyd-Franklin, 1989).

Answer A: Research suggests that a broader approach may be more useful when working with African American families.

Answer B: Research generally does not endorse the use of nondirective, nonstructured techniques when working with African American families.

Answer D: This is not the best answer. While this may have merit when working with a specific family, the consensus of research has not highlighted this as a specific technique that is more effective with African American families.

B

In this situation, the therapist is prescribing the symptom. Prescribing involves instructing the client to maintain and/or exaggerate the target symptom.

Answer A: Reframing involves shifting the meaning or frame of reference of symptomatic behavior.

Answer C: When using positioning, the therapist accepts and exaggerates the client's assertions about his/her problems.

Answer D: "Exaggerating" is not an actual technique used by a family therapist.

C

Therapists experience stress and burnout for several reasons. Not surprisingly, the most difficult situation--i.e., the one requiring an immediate response--is the one that is associated with the greatest stress. Surveys of therapists have revealed that suicidal ideation and threats are considered the most stress-producing client behaviors.

Answers A, B, and D: While each of these responses certainly impacts therapist stress level, research has shown that suicidal statements reportedly cause therapists the most stress.

C

Interpersonal therapy (IPT) is a brief structured manual-based therapy that was originally developed as a treatment for depression but has since been applied to other disorders. Its primary targets are the four problem areas listed in this response.

Answer A: These concepts are related to personal construct therapy.

Answer B: These are Gestaltian concepts.

Answer D: This sounds more like solution-focused therapy.

B

As described by Bateson et al. (1956), double-bind communication occurs when a family member receives contradictory injunctions (messages) from another family member and is unable to comment on those injunctions or escape from them. The title of Bateson et al.'s 1956 paper was Toward a Theory of Schizophrenia. Their double-bind hypothesis provided an alternative to psychodynamic theory regarding the development of this disorder and proposed that the recipient of double-bind communication learns to escape the discomfort it creates by responding with similarly distorted and contradictory messages. Eventually, the individual becomes unable to understand the true meaning of his/her own messages and those of others.

Answer A: Double-bind communication was not theorized to be connected to the development of anorexia.

Answer C and D: Bateson and colleagues did not include theorizations about personality disorder development when discussing double-bind communication.

A

Minuchin's structural approach to family therapy utilizes techniques to alter the family's structure. Minuchin's structural family therapy can be characterized as "manipulative, unyielding, and crisis provoking" (Goldenberg & Goldenberg, (1985), Family therapy: An overview, p. 185). It uses a number of techniques to restructure a family's transactional patterns including marking boundaries, escalating stress, utilizing symptoms, and manipulating mood. When using the latter technique, the therapist might imitate, in an exaggerated way, the family's style in order to point out their dysfunctional patterns.

Answer B: One criticism of Minuchin's approach is that it does not emphasize fostering insight and understanding.

Answer C: The genogram was developed by Bowen and is used primarily by family systems (Bowenian) therapists in order to clarify a family's multigenerational relationship systems.

Answer D: The therapeutic double-bind, used primarily by communications family therapists, was an outgrowth of research on the pathological double-bind conducted by Don Jackson and his colleagues.

B

Unlike consultants, supervisors have administrative responsibility for and are in a position of power over the supervised.

Answer A: Consultation may focus on the development of the consultees clinical skills, knowledge, or abilities.

Answer C: Consultants may meet with consultees on numerous occasions.

Answer D: Supervision, consultation, and mentorship are distinct roles.

B

Knowing that Gestalt therapists focus on the here-and-now in therapy would have helped you identify the correct response to this question.

Answer A, C, and D: Gestalt therapists do not deny the significance of the past. However, in therapy, they encourage clients to stay in the present even when discussing past events or feelings since focusing on the past is viewed as a way to avoid the present

D

This description is more in line with the traditional notion of cultural competence which is distinguished from cultural humility. One significant criticism of the traditional notion of cultural competence is that it overemphasizes trite knowledge acquisition that often stereotypes cultural groups rather than lending to a nuanced understanding of cultural diversity.

Answers A, B, and C: Proponents of cultural humility hold that this concept balances necessary knowledge acquisition with "a greater emphasis on a life-long commitment; encourages nurturing of self-evaluation and critique; addresses power imbalances; promotes interpersonal sensitivity; requires an attitude of openness and egolessness; involves supportive interaction; entails maintaining an interpersonal stance that is other-oriented; necessitates learning from differences" (Campinha-Bacote, 2018).

A

Each stage of the Racial/Cultural Identity Development Model is characterized by a different set of attitudes toward members of one's own minority group, members of other minority groups, and members of the dominant group.

Answer B: The model is centered around changes in attitudes rather than behaviors.

Answer C: Levels of acculturation are not explicitly detailed in this model.

Answer D: The development of ego identity is one of the primary elements of Erikson's psychosocial stage theory.

B

For the exam, you want to be able to distinguish between primary, secondary, and tertiary preventions. Secondary preventions are offered to specific individuals who have been identified as being at high risk by some type of screening procedure.

Answer A: As defined by most experts, primary preventions are offered to groups of individuals rather than to specific individuals who have been identified as being at high risk for a disorder.

Answer C: Tertiary preventions are for people who have already developed a disorder and are aimed at reducing relapse and other negative consequences.

Answer D: This is not a type of prevention.

C

Gestalt therapists use the term introjection to describe an overly permeable boundary between the person and the environment. From this perspective, neurotic behavior is often the result of a disturbance in the boundary between the person and his/her external environment.

Answer A: This concept is described in psychoanalytic literature.

Answer B: Perls did theorize about the concept of a self-image, however, an image of disturbance is not an actual term used in his theory.

Answer D: The main difference between Freud's and Perls' conceptualization of defense mechanisms is that Freud viewed defense mechanisms as an id-ego interaction; however, Perls viewed defense mechanisms as a boundary disturbance.

A

Yalom and others have conducted research to identify the curative factors that group members consider most important. Although the results of research on Yalom's curative factors vary, depending on the type of therapy group, these four factors are often cited as most critical by group therapy members.

Answer B: Universality and instillation of hope are not included among the four most cited curative factors.

Answer C: Of the four factors listed in this answer, only catharsis is included among the four most cited curative factors.

Answer D: None of these factors are included among the four most cited curative factors.

D

Practitioners of psychodynamic psychotherapy are interested in the impact of unconscious issues on current behavior. Object relations family therapy is a psychodynamic therapy that links intrapsychic phenomena to current family relationships.

Answers A, B, and C: Of the responses listed, only object relations family therapy is psychodynamic therapy. As such, this approach involves making the unconscious conscious.

C

Berry (1987) distinguishes between four levels of acculturation including integration, assimilation, separation, and marginalization. A person in the separation category rejects the majority culture and identifies with his/her own minority culture.

Answer A: A person in the marginalization category does not identify with his/her own minority culture or with the majority culture.

Answer B: A person who identifies with his/her own minority culture but also adopts aspects of the majority culture who be classified in the integration category.

Answer D: A person is categorized in the assimilation category when he/she adopts the characteristics of the majority culture and rejects his/her own minority culture.

C

One of the problems with the use of hypnosis to recall memories is that people tend to be more certain about the accuracy of those memories, whether they are true or false. The research has shown that people are often more willing to accept false memories when those memories have been retrieved under hypnosis.

Answer A: Research findings suggest that people often continue to believe in the authenticity of "recovered" memories post hypnosis.

Answer B: Research findings do not suggest that people later become skeptical of memories "recovered" under hypnosis.

Answer D: Empirical evidence does not support this statemen

B

For research purposes, therapist effects refer to the collective impact that a clinician has on client outcome independent of the treatment modality or therapeutic technique utilized. Any possible impact that a therapist has on treatment outcome, with the exception of the two aforementioned variables, are classified as 'therapist effects'.

Answer A: The therapist's race/ethnicity would be considered a therapist effect.

Answer C: The therapist's level of experience would also be considered a therapist effect.

Answer D: The therapist's choice of decor would also be considered a therapist effect if this impacted treatment outcome.

D

In this situation, the boy is trying to prevent a change in the family's status. Homeostasis is the tendency of a system to maintain the status quo. In the situation described in the question, the boy's behavior is serving to maintain the family system by keeping his parents together.

Answer A: Incorrect Scapegoating occurs when a family member (the scapegoat) is placed in a role that exposes him/her to blame, criticism, etc.

Answer B: The boy's behavior does not seem relevant to the concept of boundaries.

Answer C: Positive feedback causes change in a system, while negative feedback serves to maintain the status quo. The boy's behavior is an example of negative feedback because it keeps the family together.

C

For the exam, you want to be familiar with the general guidelines for working with members of diverse populations provided in the Clinical Psychology chapter. An initial step when working with clients from culturally diverse groups is to identify the client's stage of racial/ethnic identity development, degree of acculturation, and worldview (beliefs, values, attitudes, etc.).

Answer A: Asking each family member to describe his/her perceptions of the family's problems may be unfruitful given their cultural background. Research findings suggest that members of Asian cultures typically adhere to a hierarchical family structure with traditional gender roles and place greater emphasis on the group than on the individual.

Answer B: According to research, establishing an egalitarian relationship is not a strategy that has been found effective for most Asian and Asian American therapy clients who usually view the therapist as an expert and authority figure.

Answer D: Adopting a "colorblind" approach would be unethical and evidence a lack of cultural competence. APA guidelines, instead, require psychologists to always consider the impact of culture on the therapeutic process.

D

Yalom views conflict as a normal part of group therapy and considers it to be a useful therapeutic tool if handled correctly. According to Yalom, the therapeutic use of conflict in group therapy involves two stages: experience (affective expression) and understanding of that experience.

Answer A: Yalom would not advocate immediately diffusing conflict as he saw this as normative and useful when handled appropriately.

Answer B: Yalom did not view conflict as resistance.

Answer C: Yalom endorsed expression of group conflict and highlighted understanding of this conflict over a focus on resolution.

D

For feminist therapists, a primary goal of therapy is helping the client understand and appropriately respond to forces in the environment that impact the client's life. Feminist therapists are more likely to avoid labeling aspects of the personality as "masculine" or "feminine".

Answer A: Feminist therapists emphasize the role of sociopolitical factors in maladaptive behavior and, therefore, a goal of therapy is to help the client understand that the "personal is political".

Answer B: Feminist therapists regard the relationship between therapist and client as a relationship between equals and use it as a model of equality to help female clients overcome barriers created by traditional roles and relationships.

Answer C: Feminist therapists view the therapeutic relationship as an opportunity to model egalitarianism and other adaptive behaviors.

C

Ridley presents a "typology of black client self-disclosure," which relates the willingness to self-disclose to four levels of "paranoia": intercultural nonparanoic disclosure; functional paranoiac; healthy cultural paranoiac; and confluent paranoiac (Clinical assessment of the nondisclosure of the black client, American Psychologist, 39(11), 1234-1244, 1984). Ridley recommends that therapists confront the meaning of the client's cultural paranoia by bringing his/her feelings into conscious awareness and then help the client clarify when it is appropriate or inappropriate to self-disclose.

Answer A: This is probably the best course of action, according to Ridley, for the confluent paranoiac but isn't necessary for the individual experiencing healthy cultural paranoia.

Answer B: This isn't the best response since healthy cultural paranoia may not need to be "ameliorated".

Answer D: This is not the course of action recommended by Ridley.

D

Deborah Ledley, Edna Foa, and Jonathan Hubbert consulted with David Clark to publish a 2005 treatment manual entitled Comprehensive Cognitive Behavior Therapy for Social Phobia. This publication was revised by Herbert, Forman, & Yuen in 2009.

Answer A: Marsha Linehan is well-known for her manualized publications which address CBT and DBT treatment of borderline personality disorder.

Answer B: A number of researchers have published treatment protocols specific to PTSD. For instance, Prolonged Exposure Therapy for PTSD is a well-known PTSD treatment protocol that was published by Foa, Hembree, & Rothbaum.

Answer C: While a number of CBT protocols for the treatment of depression have been developed, this particular manual focuses on the treatment of social phobia.

A

Primary preventions attempt to reduce the prevalence of physical or mental disorders by reducing the incidence of new cases. This program is a primary prevention. It is being offered to all students (rather than to specific students) in an effort to reduce the future occurrence of problems related to interpersonal relationships.

Answer B: This is an example of tertiary prevention. Tertiary preventions are designed to reduce the duration and consequences of mental disorders.

Answer C: This is an example of secondary prevention. It involves providing identified individuals with appropriate interventions to reduce the occurrence of educational failures.

Answer D: This program would not be labeled as primary given that the target population has been selected due to a current diagnosed mental health disorder. The goal of a primary intervention is to reduce the incidence of new cases.

D

A primary goal of Milan systemic family therapy is to "help family members see their choices and to assist them in exercising their prerogative of choosing" (Gelcer, McCabe, & Smith-Resnick, 1990, p. 22). For systemic therapists, questions are not only a means for obtaining information but also act as a therapeutic intervention. Circular questions help define and clarify confused ideas and behaviors and introduce new information to family members.

Answer A: Systemic family therapists view therapy as facilitative and, therefore, avoid the use of directives.

Answer B: As used by Minuchin, the term "holon" refers to the concept that a phenomenon is simultaneously a whole and its parts.

Answer C: Maneuvers, coalitions, and games are avoided by systemic therapists because they are more directive than facilitative.

A

Parallel process occurs in clinical supervision when the therapist (supervisee) behaves toward the supervisor in ways that mirror how the client is behaving toward the therapist. 

Answer B: Consultation is distinct from clinical supervision. Mental health consultation is largely attributed to Caplan (1970), who distinguished between four different types of mental health consultation involving three different individuals or entities. 

Answer C: In Janet Helms’ White Racial Identity Development Model (1990, 1995), a parallel interaction occurs when the client and therapist have the same (or similar) levels of racial/cultural identity. 

Answer D: The triangular model is a form of supervision that emphasizes providing service to clients that includes organizational policies, professional knowledge, and the supervisory relationship.

B

According to Rogers, the therapist's role is to provide the client with three facilitative conditions including empathy, genuineness, and unconditional positive regard. He proposed that these conditions enable the client to return to his/her natural tendency for self-actualization. The instillation of hope is one of Yalom's curative factors. While Rogers likely would not have diminished the value of instilling and holding hope for clients, he did not include this factor as one of the three facilitative conditions for change.

Answer A: Rogers defined accurate empathy as the therapist's ability to see the client's worldview and relay this understanding to the client.

Answer C: Rogers believed that therapists must be genuine as inauthenticity leads to mistrust.

Answer D: Rogers proposed that the therapist's regard for the client is vital in therapy as this regard impacts the client's sense of worth.

C

Yalom (1985) identified several types of people who are and are not likely to benefit from group therapy. According to Yalom, heterogeneous outpatient groups are inappropriate for sociopaths (although these individuals may benefit from homogeneous groups in inpatient or other controlled settings).

Answer A: According to Yalom, a person experiencing anhedonia is a good candidate for group therapy.

Answer B: Workaholics are also good candidates for group therapy.

Answer D: Yalom believed that disorders related to social interactions are amenable to group therapy.

A

Herek attributes violence against "homosexuals" to heterosexism which he defines as an "ideological system that denies, denigrates, and stigmatizes among nonheterosexual forms of behavior, identity, relationships, or community" (p. 150). [Psychological heterosexism and anti-gay violence: The social psychology of bigotry. In G. M. Herek & K. T. Berrill, Hate crimes: Confronting violence against lesbians and gay men (pp. 149-169), Newbury Park, Sage, 1992]. For the exam, you want to be familiar with the terms Herek uses as alternatives to homophobia -- i.e., sexual stigma, heterosexism, and sexual prejudice.

Answer B: Herek proposed replacing the word homophobia as he believed that the term was imprecise and ambiguous.

Answer C: This term has a much broader meaning.

Answer D: Herek used the term "sexual stigma" rather than "sexual bias".

D

Freud's personality theory emphasizes conflicts between internal instincts and the external demands of reality. Answer D is the best description of Freud's conceptualization of anxiety as it is the only response that addresses both internal and external threats.

Answer A: This best describes Kelly's definition of anxiety.

Answer B: This is Roger's view of anxiety.

Answer C: Horney referred to this as "basic anxiety".

C

In this situation, the clients are being provided with services that are intended to reduce the likelihood of future drug abuse (relapse). Rehabilitation is the goal of tertiary preventions.

Answer A: Primary preventions emphasize counteracting harmful circumstances before they have an opportunity to produce mental or physical illness.

Answer B: Secondary preventions emphasize the early diagnosis and treatment of disorders.

Answer D: This is a "made up" term.

C

Freud viewed countertransference as an obstacle to the progress of therapy, but other psychodynamic theorists have redefined it as a potential source of useful information about clients.

Answer A: Identification has several meanings in psychology, but this is not one of them. One definition describes it as the process of associating oneself with other people and assuming their attitudes, behaviors, etc.

Answer B: Primary process is the type of thinking that is a function of the id and is guided by the pleasure principle.

Answer D: Introjection also has more than one definition but none are applicable to this question. For example, Gestaltians define introjection as a boundary disturbance that involves incorporating another person's values and beliefs into one's own personality without fully understanding them.

B

According to the transtheoretical model, a person in the maintenance stage has maintained a change of behavior for at least six months and is taking steps to prevent relapse. 

Answer A: A person in the termination stage feels that there is no risk for relapse and is not actively taking steps for relapse prevention. 

Answer C: In the action stage, the person takes active and concrete steps for behavior change. For this person, the initial steps taken toward sobriety may have been in the action stage, but his current circumstances are better reflected by the maintenance stage. 

Answer D: Prevention is not a stage in the transtheoretical model; however, relapse prevention is part of the maintenance stage.

D

Helms's six identity statuses are contact, disintegration, reintegration, pseudo-independence, immersion/emersion, and autonomy. For the exam, you want to be familiar with the order and characteristics of each status. Contact is the first status in Helms's model. It is characterized by a lack of awareness of racial identity and often by racist attitudes and beliefs.

Answer A: Internalization is the final stage in Cross's Black Racial Identity Development Model.

Answer B: Integrative awareness is the final stage of the Racial/ Cultural Identity Development Model.

Answer C: Reintegration is the third status in Helm's model.

C

Caplan states that the primary targets of consultee-centered case consultation are the consultee's skills, knowledge, and/or objectivity. Caplan defines theme interference as a type of transference that occurs when a consultee's unresolved conflict related to a particular type of client or situation interferes with his/her objectivity when working with similar clients or in similar situations.

Answer A: Mahler's model of early development includes a "symbiotic phase", however, this has no relation to Caplan's theory.

Answer B: Diagnostic overshadowing is a term that captures the bias which leads clinicians to attribute all of a person's psychiatric symptoms to his or her intellectual disability.

Answer D: Parallel process occurs when a therapist (supervisee) replicates problems and symptoms with the supervisor that are being manifested by the therapist's client.

B

Research relating to the correlates of sexual prejudice has generally evidenced higher levels of sexual prejudice among heterosexual men versus heterosexual women, individuals who are older, those with fewer years of formal education, residents of Southern states, Midwestern states, or rural areas, and those who have limited contact with the LGBTQ+ community (Herek, 2000). Studies have also found correlations between higher levels of sexual prejudice and authoritarianism, affiliation with a fundamentalist religious denomination, and conservative political views. Choice B is the best answer as it presents two of the above correlates (level of education and Southern region).

Answer A: According to Herek's correlates, this group would be the least likely to have a higher level of sexual prejudice than the general population.

Answer C: This is not the best answer as only one correlate is evident (Midwestern state).

Answer D: This answer choice only presents one correlate (male heterosexual orientation).

B

The task described in the question is an example of an "ordeal". For the exam, you should have paradoxical techniques and ordeals associated with Milton Erickson and Jay Haley (who was strongly influenced by Erickson).

Answer A: Luigi Boscolo is affiliated with the Milan systemic school of family therapy, which is not associated with the use of ordeals.

Answer C: The use of ordeals is more associated with Erikson and Haley than with Minuchin.

Answer D: Sade was a French philosopher who has been linked to the concept of sadomasochism.

C

Systems theory underlies family therapy, in which a family is viewed as an open system that interacts with the environment. Open systems respond to input by modifying or elaborating structural elements. Under some conditions, the system will react in a way that maintains homeostasis; in other conditions, the system changes or adapts to the new input.

Answers A, B, and D:  Consistent with systems theory, family therapists view the family as primarily an open system. An open system continuously receives input from and discharges output to the environment and is more adaptable to change.

C

A teleological approach views behavior and personality as being "pulled" by a subjective future rather than being "pushed" by an objective past (e.g., by heredity or environmental events). A distinguishing characteristic of Adler's approach is its teleological explanation for behavior. Adler believed that behavior is determined by future goals.

Answer A: Skinner viewed behavior as the result of the past consequences of the behavior.

Answer B: Bowen is a family therapist who regards severe mental disorders (e.g., Schizophrenia) as the result of a multigenerational transmission process. Therefore, his approach would not be described as teleological.

Answer D: Freud viewed current behavior as the result of innate factors and past experiences.

C

Defense mechanisms are used by the ego to prevent conscious awareness of anxiety-producing impulses, thoughts, and desires. Although defense mechanisms vary with regard to their processes and manifestations, they all represent a distortion or denial of reality and operate unconsciously. Reaction formation involves acting in a manner opposite to one's inclinations; i.e., defending against a disturbing impulse by actively expressing its opposite.

Answer A: Regression involves a return or retreat to a previous stage of development.

Answer B: Introjection involves ascribing the thoughts and behaviors of others to oneself in order to better control one's affective responses to those thoughts and behaviors.

Answer D: Displacement involves a transfer of unacceptable feelings associated with one object to a more acceptable or safe object.

C

Personalismo sounds like what it is - i.e., communication that fosters warmth, rapport, and a personal connection. Although formalismo (a formal communication style) is generally preferred by Latino/Hispanic clients during initial therapy sessions, personalismo is preferred once the therapeutic alliance has been established.

Answer A: Integrating members of the extended family into the intervention would be consistent with the value of familismo.

Answer B: Maintaining a neutral attitude is not consistent with personalismo.

Answer D: Demonstrating knowledge of indigenous healing practices may be important but would not necessarily foster personalismo.

D

Individuation is a key concept in Jung's personality theory. Jung described individuation as a lifelong process that consists of integrating or harmonizing components of the conscious and unconscious.

Answer A: Adler, rather than Jung, made theorizations pertaining to one's style of life.

Answer B: Adler, rather than Jung, is known for making postulations about feelings of inferiority.

Answer C: This is a Gestaltian concept.

A

Existential therapies are derived from existential philosophy and share an emphasis on the human conditions of depersonalization, loneliness, and isolation. For existential therapists, behaviors commonly perceived as "maladaptive" are a natural part of being human. Existential anxiety, for example, is conceptualized as a normal response to the constant threat of nonbeing (death).

Answer B: Existential anxiety relates to death rather than birth.

Answer C: This is not true of existential anxiety.

Answer D: The concept of unresolved conflict is linked with Freudian theory.

B


Wrenn (1962) was among the first to point out that mental health professionals frequently fail to consider the impact of culture in their work with clients. As defined by Wrenn, therapists are culturally encapsulated when they interpret everyone's reality through their own cultural assumptions and stereotypes and are unaware of their own cultural biases.

Answer A: The opposite is true.

Answer C: Culturally encapsulated therapists do not refuse to work with clients from other cultures.

Answer D: Culturally encapsulated therapists lack cultural awareness.

B

According to Rogers, for an individual to achieve self-actualization, his/her sense of self must remain unified, organized, and whole. Rogers believed that the self can become disorganized when there is incongruence between the self and experience. This occurs when the individual experiences conditions of worth (e.g., is given attention or affection only when he/she acts in certain ways.).

Answer A: Person-centered therapy is based on the assumption that people possess an inherent ability for growth and self-actualization and that maladaptive behavior occurs when "incongruence between self and experience" disrupts this natural tendency.

Answer C: Rogers proposed that incongruence can lead to anxiety, which the individual may attempt to alleviate by denying or distorting the self and/or the experience. Thus, incongruence may lead to diminished insight and self-awareness.

Answer D: This sounds like reality therapy.

B

Eysenck (1952) based his conclusions about the effectiveness of psychotherapy on 24 outcome studies. Eysenck concluded that the effects of psychotherapy are "small or nonexistent" and that any apparent positive effects may be due to spontaneous remission. Eysenck's conclusions were criticized on methodological grounds.

Answer A: Eysenck did not make this claim.

Answer C: This was not one of Eysenck's findings.

Answer D: This statement is not supported by Eysenck's research.

C

Troiden's (1988) Homosexual (Gay/Lesbian) Identity Development Model distinguishes between four age-related stages: sensitization, self-recognition, identity assumption, and commitment. The sensitization stage usually occurs in middle childhood. During this stage, the individual feels different from and experiences less opposite-sex interest than his/her peers and begins to experience same-sex attraction without understanding the implications of those feelings for self-identity.

Answer A: This is characteristic of the self-recognition stage which occurs at the onset of puberty.

Answer B: This is characteristic of the identity assumption stage.

Answer D: This is not characteristic of the sensitization stage.

C

Yalom describes the first few months of group therapy as involving three stages - 1) orientation, hesitant participation, search for meaning, dependency; 2) conflict, dominance, rebellion; and 3) development of cohesiveness. For the exam, you want to be familiar with the characteristics of these stages. During the first stage of group therapy, members do talk to one another, but they are likely to address their questions and seek support from the therapist.

Answer A: This is characteristic of the second stage.

Answer B: This is not characteristic of any of the stages described by Yalom.

Answer D: A struggle for power (but not necessarily using subtle means) is characteristic of the second stage.

D

Rogers proposed that, for therapy to be effective, the therapist must provide three facilitative conditions - unconditional positive regard, congruence (genuineness), and accurate empathic understanding. Congruence involves being genuine, authentic, and nondefensive.

Answer A: This sounds more like accurate empathic understanding.

Answer B: This does not describe congruence.

Answer C: This describes unconditional positive regard.

C

Haley's strategic family therapy was influenced by the communication/interaction school of family therapy and focuses on communication and other interactions between family members. For strategic family therapists, a symptom is an interpersonal phenomenon that represents an attempt to control a relationship.

Answer A: While symptoms have an emotional component, this component is part of a larger relational phenomenon.

Answer B: The opposite is true. Symptoms are relational rather than purely intrapsychic.

Answer D: Symptoms have a cognitive component but are relational.

C

Howard et al. (1986) found that the positive relationship between therapy duration and therapy outcome "levels off" at about the 26th therapy session. These investigators report that about 75% of therapy clients show "measurable improvement" by 26 sessions; and, at 52 sessions, this number increases to only about 85%.

A

Twelve-step facilitation therapy is a manualized treatment approach developed by Nowinski, Baker, and Carroll for the treatment of alcohol use disorder. The use of role-playing is emphasized throughout this treatment manual.

Answer B: Alcoholics Anonymous programs are peer-led.

Answer C: MET is a therapeutic treatment approach that utilizes the tenets of motivational interviewing to resolve one's ambivalence about engaging in substance use treatment. While a MET treatment manual specific to alcohol use has been developed, this manual does not specifically endorse the use of role-playing.

Answer D: This is not an actual model.

A

Admission rates to psychiatric hospitals have been linked to a number of demographic characteristics including gender, age, and marital status. Admission rates to state and country psychiatric hospitals are higher for males than for females. In addition, psychiatric inpatients are more likely to be single (never married) and between the ages of 25 and 44. Thus, single never-married men in their 30's meet all three risk factors.

C

In psychoanalysis, the analysis of the client's free associations, dreams, resistances, and transferences involves four processes. Clarification and confrontation help the client become aware of the unconscious conflicts that are affecting his/her current behaviors; interpretation more explicitly links current behaviors to past events; working through helps the client incorporate new insights into his or her personality.

Answer A: Frustration is not one of the four processes.

Answer B: Frustration and expiation are not components of the four processes.

Answer D: Manipulation and abreaction are not components of the four processes.

A

Knowing that the transtheoretical model is also known as the stages of change model would have helped you identify the correct answer to this question. The transtheoretical model is based on the premise that interventions are most effective when they match the client's stage of change. For example, clients in the precontemplation stage benefit most from information that increases their knowledge and motivation to change; while those in the preparation stage need assistance in identifying appropriate change strategies.

Answer B: While there may be truth to this statement, the transtheoretical model is not based on this premise.

Answer C: Critics of the model hold that it does not stress the importance of the social context in which change occurs.

Answer D: The transtheoretical model is collaborative.

B

Recognizing that the four problem areas identified in this question (grief, role disputes, role transitions, and interpersonal deficits) are all related to interpersonal issues may have helped you identify the correct answer to this question even if you're unfamiliar with interpersonal psychotherapy. Practitioners of interpersonal psychotherapy (ITP) focus on one or more of the problem areas identified in this question.

Answer A: Transactional analysis is a psychoanalytic theory and therapy that focuses on the analysis of social interactions framed within three distinct ego states (parent, adult, child).

Answer C: The primary goal of reality therapy is to help clients identify responsible and effective ways to satisfy their needs and thereby develop a successful identity.

Answer D: As the name implies, this form of therapy focuses on identifying solutions to problems rather than the etiology of these difficulties. Solution-focused therapists achieve therapy goals by utilizing questions aimed at soliciting the client's recognition of his/her own strengths and resources.

C

Sue et al. (1991) found that the effects of therapist-client matching in terms of race/ethnicity were more consistent for premature termination than for other therapy outcomes but that the effects varied from group to group. Therefore, this is the best answer of those given.

Answers A, B, and D: Sue et al. (1991) found that ethnic matching reduced premature termination rates for Asian, Hispanic, and White Americans but not for African Americans and that matching was associated with improved treatment outcomes for Hispanic American clients only.

A

The anthropologist Edward T. Hall (1969) distinguished between two types of communication - high-context and low-context - and proposed that different cultures can be described in terms of communication type. High-context communication is anchored in the situation and relies heavily on nonverbal cues and group identification and understanding. According to Hall, high-context communication is characteristic of many ethnic/cultural minority groups.

Answer B: Low-context communication relies primarily on the explicit, verbal part of a message and is characteristic of Euro-American culture.

Answer C: Family therapists distinguish between two types of family communication patterns - symmetrical and complementary. Symmetrical communications reflect equality between communicators but can escalate into a "one-upmanship" game when each participant tries to outdo the other.

Answer D: Complementary communication reflects inequality between communicators.

C

In the situation described in this question, the therapist is attributing all of the client's presenting problems to one salient characteristic (alcohol use) rather than considering other explanations for them. The bias exhibited by Dr. Chu is referred to as diagnostic overshadowing.

Answer A: A hindsight bias occurs when an individual concludes that past events were predictable.

Answer B: The false consensus effect occurs when an individual overestimates the degree to which others agree with him/her.

Answer D: The Barnum effect occurs when people are willing to accept vague descriptions of themselves (e.g., horoscopes) as accurate.

D

This was a difficult question as there would be many factors to consider when working with this client. While assessing factors related to her level of acculturation would be key to planning treatment, the question is specifically asking about what it means to implement an active, directive approach with this client. With regard to somatic complaints, for example, Sue and Sue (2003) recommend that the clinician acknowledge the symptoms and then recommend physical treatments before dealing with emotional factors. Thus, this is the best response.

Answers A, B, and C: Most of the literature on counseling Asian and Asian-American clients stresses the need to assume an active, directive role. However, an active, directive approach doesn't necessarily involve assigning a diagnosis, asking very direct personal questions, or making interpretations.

D

In this situation, the husband has given inconsistent ("double") messages to his wife. When a person is given inconsistent messages and is unable to comment on them, this is referred to as a "double-bind".

Answer A: Mystification is similar to a double-bind communication, but its purpose is to mask an underlying conflict.

Answer B: A negative feedback loop is a corrective mechanism that allows a family system to reduce deviation and maintain stability.

Answer C: Although this communication is dysfunctional, this answer is too general. Thus, answer d is a better response.

B

Yalom notes that "whether co-therapists should openly express disagreement during a group session is an issue of some controversy" (1985, p. 420). However, he believes that, in general, disagreement can be useful.

Answer A: Yalom believes that disagreements between co-therapists may be inappropriate during the first few meetings of a therapy group but, in later sessions, can contribute to treatment by providing a "model-setting experience" for group members that shows them how disagreements can be resolved.

Answer C: Yalom did not include this stipulation.

Answer D: Yalom did not qualify his support for disagreement with the requirement that it be an explicit group norm.

A

The Racial/Cultural Identity Development Model consists of five stages: conformity, dissonance, resistance and immersion, introspection, and integrative awareness. During the initial conformity stage, African Americans have positive attitudes toward Caucasian cultural values and negative attitudes toward their own culture. African American clients in the conformity stage are likely to prefer a Caucasian therapist.

Answer B: African American therapy clients in the dissonance, resistance, and immersion, or introspection stages are likely to prefer working with a therapist who is also a racial minority.

Answer C: This is true of both the introspection and resistance and immersion stage.

Answer D: This is true of the introspection stage.

B

The research on this issue was conducted over two decades ago by B. A. Farber and L. J. Heifetz [The process and dimensions of burnout in psychotherapists, Professional Psychology, 13(2), 293-301, 1982]. Farber and Heifetz found that 74% of psychologists, psychiatrists, and social workers in their study identified a lack of therapeutic success as the most stressful aspect of their professional work.

Answer A: Legal and ethical dilemmas were not identified as the single most stressful aspect of clinical work.

Answer B: Adequate training was not identified as the single most stressful aspect of clinical work.

Answer D: Personal problems were not identified as the single most stressful aspect of clinical work.

D

The self-in-relation theory is a feminist approach that combines feminist theory with object relations theory. Consistent with object relations theory, it focuses on the relationship between the mother (caregiver) and the child.

Answer A: The primary focus of Jung's analytical psychotherapy is rebridging the gap between the conscious and the personal and collective unconscious.

Answer B: A key assumption underlying reality therapy is that mental illness is the result of an individual's choices. From this perspective, a person is not depressed due to unpleasant childhood experiences or a chemical imbalance in the brain but because he or she has chosen to "depress" him/herself. Thus, reality therapists focus on current behaviors and beliefs.

Answer C: This was not a central focus of Kelly's model.

A

Adler made key postulations regarding the concepts of "feelings of inferiority" and "striving for superiority." According to Adler, real or imagined organ inferiority leads to feelings of inferiority. However, he believed that people can respond to these feelings in a constructive way and pursue goals that help them achieve superiority.

Answer B: Rogers is closely associated with the concept of unconditional positive regard.

Answer C: Perls is the founder of Gestalt psychology. His theorizations include the distinction between the self and self-image, as well as, the classification of four major boundary disturbances.

Answer D: Jung is well known for his postulations regarding the collective unconscious, archetypes, and individuation.

B

N. Boyd-Franklin (Black Families in Therapy: A Multisystems Approach, New York, Guilford Press, 1989) proposes that to successfully treat African-American families, a therapist must be willing to consider and, when feasible, to intervene at multiple levels and in multiple systems. Even if you are unfamiliar with the multisystems approach, its name implies that it involves addressing multiple systems such as the extended family, the church, schools, and social service agencies.

Answer A: This is the near opposite of a multisystems approach.

Answer C: A multisystems approach is broad and encourages collaboration with multiple systems.

Answer D: This does not describe a multisystems approach.

B

This is one of those questions that you may have been able to answer correctly just by considering the meaning of the words listed in the answers. As its name implies, reframing involves describing a symptom in a way that allows family members to view it from another perspective.

Answer A: Positioning involves exaggerating a symptom's severity.

Answer C: Prescribing is probably the most commonly used paradoxical technique. It entails instructing a client to engage in the undesirable behavior.

Answer D: Restraining involves discouraging change by implying that attempts at change will not work or will have undesirable consequences.

B

The mechanism underlying hypnosis continues to elude researchers although more recent findings link hypnosis to a disruption in communication between certain areas of the brain. Orne and Dinges, for example, conclude that the unusual behaviors exhibited by hypnotized people reflect alterations in memory, perception, and mood that occur in response to suggestion [Hypnosis, in H. I. Kaplan & B. J. Sadock (eds.), Comprehensive Textbook of Psychiatry, Baltimore, Williams Wilkins, 1989].

Answer A: A disruption in reality testing has not been identified as an explanation for hypnosis.

Answer C: Behaviors similar to those elicited from hypnotized individuals can also be elicited from non-hypnotized people in certain situations, suggesting that increased compliance to situational demands does not adequately explain the state of hypnosis.

Answer D: This was the explanation offered by James Braid in the late 1840s but is no longer considered valid.

A

The family members described in this question do not seem to be involved in or concerned about the lives of other members. From the perspective of Minuchin's structural family therapy, relationships in this family are characterized by a high degree of disengagement.

Answer B: Differentiation is most closely associated with Bowen.

Answer C: "Emotional cutoff" is most closely associated with Bowen.

Answer D: Marital skew is a term used by Lidz to describe a situation in which spouses attempt to maintain their marriage even though this requires a distortion of reality.

D

Like other humanistic therapists, Gestalt therapists view the individual as having an innate tendency for positive growth. For Gestalt therapists, neurotic behavior reflects interference with natural growth and a resulting lack of integration.

Answer A: This does not accurately describe the Gestaltian view of maladaptive behavior.

Answer B: This sounds more like cognitive views of maladaptive behavior.

Answer C: This is consistent with the assumptions of transactional analysis.

B

Structural family therapists distinguish between three rigid triads - detouring, stable coalition, and triangulation. Minuchin used the term stable coalition to describe a relationship between two family members that involves the joining of those members against a third member, which is what is occurring in the situation described in this question.

Answer A: For structural family therapists, triangulation occurs when each parent demands that the child side with him/her against the other parent.

Answer C: Positive feedback produces change and can be either "good" or "bad." You'd have to know the consequences of the mother's and son's behavior to determine if it is acting as positive feedback.

Answer D: Positioning is a paradoxical technique that involves exaggerating the severity of a symptom.

B

It is always important to take a therapy client's culture into account when deriving a diagnosis and developing a treatment plan. According to past research, Native American clients are likely to have a spiritual, holistic orientation to life that emphasizes harmony with nature.

Answer A: This would not be culturally competent or ethical. It is impossible to establish a "value-free" environment. Psychologists are instead mandated to recognize their values and biases and maintain an awareness of how this impacts the therapeutic process.

Answer C: According to past research, Native Americans may hold cultural beliefs that do not make clear distinctions between mental and physical health.

Answer D: The structure of Native American families varies; however, past research suggests that families are usually not hierarchical.

A

In the situation described in this question, the therapist has assigned the couple a task that will help them focus on the positive aspects of their relationship. In solution-focused therapy, this is an example of a "formula task." Its purpose is to help the couple identify positive aspects of their relationship that, in turn, can lead to solutions to their marital difficulties.

Answer B: While solution-focused therapists focus on solutions, Milan systemic family therapists are concerned with helping family members understand their relational problems in new ways.

Answer C: Behavioral family therapists focus on altering environmental factors that maintain problematic behavior.

Answer D: This is a behavioral marital therapy that utilizes contingency contracts to increase the number and range of positive reinforcements exchanged by couples.

A

As long as you know that joining is an initial strategy in structural family therapy, you could have identified the correct response to this question without knowing what tracking and mimesis are. Tracking involves identifying and using the family's values, life events, etc. in conversations; mimesis involves adopting the family's communication and affective styles. Both are methods for joining the family system.

Answer B: Emotional triangles are most closely associated with extended family systems therapy.

Answer C: This is the primary goal of communication/interaction family therapy.

Answer D: This is the goal of Milan systemic family therapy.

D

Interpersonal psychotherapy (ITP) is based on a medical model and views depression and other mental disorders as illnesses. As its name implies, a primary goal of ITP is improved interpersonal relationships. However, consistent with the medical model, ITP also focuses on symptom reduction.

Answer A: This is characteristic of psychotherapies based on Freudian theory.

Answer B: This sounds like existential therapy.

Answer C: This is a goal of reality therapy.

B

Jung considered the archetypes to be an important contributor to personality development. Archetypes are primordial images that are part of the collective unconscious, are passed down from one generation to the next, and cause people to experience certain phenomena in a universal way.

Answer A: This sounds more like Jung's complexes.

Answer C: The concept of the ego is not directly related to that of Jung's archetypes.

Answer D: The personal unconscious consists of experiences that were unconsciously perceived or were once conscious but are now repressed or forgotten.

A

For the exam, you want to be familiar with the therapeutic strategies of all of the therapies listed in the answers to this question. A solution-focused therapist acts as a consultant/collaborator who poses questions aimed at identifying solutions to problems, including miracle, exception, and scaling questions.

Answer B, C, and D: Of the approaches listed, solution-focused therapy is the only modality that advocates incorporating these three specific questions as a form of intervention.

B

For the exam, you want to be familiar with the basic assumptions underlying each of the therapeutic approaches listed in the answers to this question. Reality therapy focuses on the choices that people make with regard to the ways they fulfill their needs and proposes that people have the five basic needs listed in this question.

Answer A: Adlerian theory is based on the assumption that mental ailments represent a mistaken style of life, which is characterized by maladaptive attempts to compensate for feelings of inferiority, a preoccupation with achieving personal power, and a lack of social interest.

Answer C: Rogerian theory holds that people have an innate "self-actualizing tendency" that serves as the major source of motivation and guides them toward positive, healthy growth.

Answer D: George Kelly's theory is based on the premise that psychological processes are determined by how we construe events. He further asserted that the way we construe events is based on our personal constructs.

C

George Kelly is the founder of Personal Construct Therapy. This constructivist therapy focuses on how people "construe" events and proposes that construing involves reliance on personal constructs.

Answer A: William Glasser developed Reality Therapy.

Answer B: Salvador Minuchin developed Structural Family Therapy.

Answer D: Fritz Perls developed Gestalt Therapy.

D

The concept of a "placebo" was originally derived from medical research. In medical research, a placebo is an inert (inactive) substance or treatment. However, in psychotherapy research, a placebo treatment usually involves providing participants with the nonspecific factors of therapy such as attention and support.

Answer A and B: Treatments known to have either a positive or negative therapeutic effect would not be considered placebo treatments.

Answer C: This is more congruent with the medical definition of a placebo.

C

As its name implies, advocacy consultation involves acting as an advocate. It is a political form of consultation that has, as its primary goal, social change.

Answers A, B, and D: Providing advocacy consultation inherently involves working with a disenfranchised population. Only one of the four responses describes a population that is clearly disenfranchised.

A

The type of questions used by family therapists has been addressed by K. Tomm (Interventive interviewing: III. Intending to ask lineal, circular, strategic, or reflexive questions?, Family Process, 27, 1-15, 1988). Circular questions are based on an assumption of circular causality and are used to explore recurrent family patterns.

Answer B: Lineal questions assume linear cause-effect relationships and are used to identify family problem(s).

Answer C: Strategic questions are challenging questions designed to foster change.

Answer D: Reflexive questions foster reflection on the part of family members so that new options can be identified.

A

The transtheoretical model predicts that an intervention is most effective when it matches the individual's stage of change. From the perspective of the transtheoretical model, a person is in the preparation stage when he/she has a clear intent to take action in the immediate future (usually defined as within the next month).

Answer B: A person in the contemplation stage is planning to take steps to change in the more distant future (usually defined as within the next six months).

Answer C: A person in the precontemplation stage has no intention of changing in the foreseeable future.

Answer D: People in the action phase have already started making changes in their lives.

B

George Kelly developed Personal construct therapy (PCT) in the 1950s as both a theory of personality and approach to therapy. Personal construct therapy (also known as "constructive alternativism") is based on the premise that people construe (construct) their own experiences. His approach was very influential in the development of narrative-constructivist approaches to therapy.

Answer A: Gerald Klerman and colleagues are credited with the development of Interpersonal psychotherapy (IPT).

Answer C: Steve Hayes is the founder of Acceptance and commitment therapy (ACT).

Answer D: Steve de Shazer and colleagues are credited with the development of Solution-focused therapy.

B

Differentiation is an important concept for Bowen. He proposed that when family members are highly differentiated, they are less likely to become emotionally fused with other family members.

Answer A: Disengagement is a term associated more with Minuchin than with Bowen.

Answer C: Engagement is a "made up" term that has no association with Bowen's work.

Answer D: According to Bowen, an undifferentiated family ego mass is one where members are highly emotionally fused.

B

Herek believed that violence against individuals who are gay and lesbian is the result of a combination of psychological (individual) and cultural heterosexism. He proposed that the word homophobia should be replaced by three terms (sexual stigma, sexual prejudice, and heterosexism) as it is ambiguous and imprecise.

Answer A: These are not actual terms.

Answers C and D: Sexual bias is not an actual term.

C

Strategic family therapy is most associated with Jay Haley, who was strongly influenced by the communication school of family therapy and by the work of Milton Erickson. Haley relies heavily on paradoxical techniques (like the one described in this response), which are also employed by communication family therapists and Milton Erickson.

Answer A: Haley focuses more on the present, especially communication patterns occurring in the present.

Answer B: This is not characteristic of strategic family therapy.

Answer D: This sounds more like Bowenian family therapy.

B

Introjection occurs when a person incorporates aspects of another person into him/herself. The boundary is located inside one, thereby allowing others to be incorporated into the self.

Answer A: This is projection.

Answer C: This is retroflection.

Answer D: This is deflection.

A

Separation-individuation is a key concept in Mahler's object relations theory. It takes place during the third and final stage in the development of object relations. Mahler viewed separation-individuation as the result of a separation between the self and other that occurs when the individual develops "emotional object constancy".

Answer B: This does not accurately describe Mahler's views regarding separation-individuation.

Answer C: This better describes Fairbairn's object relations theory.

Answer D: This sounds more like ego psychology than object relations theory.

B

Motivational interviewing has been defined by Miller and Rollinick as an approach designed to help clients build commitment and readiness to change (Motivational Interviewing, New York: Guilford, 1991). It is based on the assumption that interventions are most effective when they are matched to the individual's level of readiness.

Answers A and C: While behavioral techniques do focus on changing one's behavior, motivational interviewing is the only approach listed that was specifically developed to address ambivalence towards behavior change.

Answer D: Self-control techniques incorporate self-monitoring and self-reinforcement and are used for a variety of disorders. They do not explicitly address a client's readiness to change behavior.

C

This statement was made by Otto Kernberg (Object relations theory and clinical psychoanalysis, New York: Jason-Aronson, 1976). Kernberg's statement reflects the object relations view that early social relations impact future social situations.

Answer A: This statement does not reflect the basic assumptions of Gestalt therapy.

Answer B: This statement is not consistent with the basic assumptions of reality therapy.

Answer D: This statement is not consistent with the basic assumptions of cognitive-behavioral therapy.

A

Ho, Boyd-Franklin, and others recommend that interventions with African-American clients (especially those from low-income backgrounds) incorporate multiple systems including the immediate family, extended family, social service agencies, and church. While Boyd-Franklin refers to this approach as a "multisystems model," Ho uses the term "ecostructural." See, e.g., M. K. Ho, Family therapy with ethnic minorities, Newbury Park, Sage, 1987.

Answer B: Boyd-Franklin used this terminology.

Answer C: Culturally competent models do not promote etic orientations.

Answer D: This term denotes a field of study rather than a model.

D

Helms's model of White identity development includes six statuses: contact, disintegration, reintegration, pseudo-independence, immersion-emersion, and autonomy. The disintegration phase, which is marked by considerable conflict, may be resolved by adopting traditional racist views, which characterizes the reintegration phase.

Answer A: This is more characteristic of immersion-emersion and autonomy statuses.

Answer B: This is not characteristic of any of the stages described by Helms.

Answer C: This is characteristic of immersion-emersion status.

C

As its name implies, Minuchin's structural family therapy focuses on the structural characteristics of the family. Minuchin considered maladaptive behavior to be the result of overly rigid or permeable boundaries between family members.

Answer A: Although communication patterns provide clues about family structure, this is not the best response of those given.

Answer B: This sounds more like Bowenian family therapy.

Answer D: Exceptions are of interest to solution-focused therapists

C

An alloplastic intervention alters environmental conditions that contribute to or cause personal distress.

Answer A: Emic refers to a culture-specific approach that recognizes differences between cultures.

Answer B: Etic refers to a universalistic approach that applies universal principles to all cultures.

Answer D: An autoplastic intervention attempts to change the individual so that he/she can function more effectively in his/her environment.

C

Gay and lesbian adolescents face similar problems as their heterosexual peers. However, their identity development is also complicated by stigmatization. Isolation is frequently cited as a primary problem for gay and lesbian adolescents, and one study found it to be the single-most frequent presenting problem (A. D. Martin and E. S. Hetrick, The stigmatization of the gay and lesbian adolescent, Journal of Homosexuality, 15(1-2), 163-183, 1988).

Answers A, B, and D: Nonheterosexual identifying youth are more likely than heterosexual youth to experience depression, anxiety, and substance use; however, this may not always be the primary presenting concern for these youth. This was demonstrated in Martin and Hetrick's 1988 study.

D

The term historical trauma was coined by Maria Yellow Horse Braveheart in the 1980s. It is defined as "cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma experiences" (Braveheart, 2003).

Answer A: William Cross developed the Black Racial Identity Development Model.

Answer B: Janet Helms developed the White Racial Identity Development Model.

Answer C: Sue contributed to the development of the Racial/Cultural Identity Development Model.

D

Rogerian therapists tend to de-emphasize both diagnosis and assessment.

Answers A, B, and C: Rogerian therapists usually reject diagnosis on the ground that it places the therapist in a superior, authoritarian role that can impede the development of autonomy and self-actualization in the client.

D

This is a difficult question because this issue has been investigated in only a few empirical studies. In a 2000 study, R. C. Savin-Williams and L. M. Diamond compared the sexual identity milestones for individuals who identified as gay or lesbian. They found that the average age of disclosure was not substantially different. They also report the results of previous research, which is generally consistent with their findings. Note that Savin-Williams and Diamond did find significant differences for initial same-sex sexual contact and first self-labeling as gay or lesbian, with the average age for both milestones being lower for those who identified as gay versus lesbian [Sexual identity trajectories among sexual-minority youths: Gender comparisons, Archives of Sexual Behavior, 29, 607-627, 2000].

Answers A, B, and C: Research has not evidenced a substantial difference in the age of disclosure among individuals who are gay and those who are lesbian.

B

High-context communication is grounded in the situation, depends on group understanding, relies heavily on nonverbal cues, helps unify a culture, and is slow to change. In contrast, low-context communication relies primarily on the explicit, verbal part of a message. While Anglo Americans often rely on verbal messages (low-context communication), African Americans and a number of other racial minority groups make greater use of nonverbal cues. African Americans, for example, tend to rely more on body language than Anglo Americans.

Answer A: The opposite is true.

Answer C: High-context communication is not exclusively related to one's gaze but encompasses a range of nonverbal communications.

Answer D: High-context communication is not exclusive to eye contact but has a much broader context.

D

As described by Minuchin, joining is both a diagnostic and restructuring technique. It involves relating to family members and the family system by, for example, adopting its communication style. In order to join the family, the therapist must be able to adapt or accommodate to its style.

Answer A: The determining factor with joining is the therapist rather than the family.

Answer B: It is the therapist rather than the family that determines the success of joining.

Answer C: Joining requires engagement rather than neutrality.

D

The transtheoretical model distinguishes between six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Prochaska, Norcross, and DiClemente recommend this combination of change processes for helping clients transition from the precontemplation to the contemplation stage.

Answer A: The optimal combination of change processes for clients in the maintenance stage is supportive (helpful) relationships, commitment, countering, environmental control, and social liberation.

Answer B: Conformity is not one of the stages of change identified by Prochaska, Norcross, and DiClemente.

Answer C: The most effective change processes for clients in the action stage are the same as those for clients in the maintenance stage (answer A).

A

Reminiscing is a common and natural activity among the elderly. Therapists should not be upset when clients devote some of the time in therapy reminiscing about their past. In fact, one therapeutic approach (reminiscence therapy) specifically incorporates this activity in the treatment process.

Answer B, C, and D: These interventions would not be therapeutic or beneficial to the client-therapist relationship.

B

Weak intersectionality relates to an individual's various intersecting social or cultural identities; whereas, strong intersectionality relates to the broader inter-related sociostructural dimensions in which those identities exist.

Answer A: This is how "weak intersectionality" is often defined.

Answer C: This does not define strong intersectionality.

Answer D: Intersectionality is not defined by personality characteristics.

C

Methods of prevention are often categorized as primary, secondary, or tertiary. The goal of tertiary prevention is to prevent a problem from becoming chronic or to prevent relapse.

Answer A: Primary preventions are designed to keep a problem from developing.

Answer B: Secondary preventions are aimed at early identification and intervention.

Answer D: This is not one of the three types of prevention.

B

According to past research, Hispanic clients (especially those who are less acculturated to the dominant White middle-class culture) are more likely to prefer an informal approach.

Answer A: According to past research, this perspective is compatible with a number of Hispanic cultures.

Answer C: Researchers recommend a multi-modal approach with Hispanic clients that addresses all aspects of functioning (e.g., behavioral, cognitive, affective, interpersonal relationships).

Answer D: According to past research Hispanic populations may exhibit greater concern for the present, than the future. Thus, a here-and-now approach is generally considered useful.

B

For the exam, you want to be familiar with the primary distinguishing characteristics of the different forms of family therapy. According to Bowen, Schizophrenia and other severe mental disorders require several generations to develop.

Answer A: Projective identification is of interest to object relations therapists.

Answer C: This was not identified by Bowen as a contributor to Schizophrenia.

Answer D: Dysfunctional communication is a focus of many forms of family therapy but is not considered by Bowen as a key contributor to severe forms of maladaptive behavior.