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Psychotherapy Test 1 100%
VERIFIED ANSWERS
2024/2025 CORRECT STUDY
SET
What is psychotherapy? Psychotherapy utilizes specific techniques and can only occur within the context of a 'therapeutic relationship'. It is used to treat disorders of thought, cognition, mood, emotional regulation, perception or memory. These disorders must seriously impair an individual's judgement, insight, behaviour, communication or social functioning. What are the factors involved in the growth and change in treatment of mental health counselling and psychotherapy?
- De-institution
- Re-evaluation of the cost effectiveness of existing treatments ) i.e. long-term vs. short-term, impatient vs. outpatient)
- Mental health prevalence studies
- Social cost studies (CCSA)
- Social reforms
- Advances in neurobiology
- Influence of social-work perspectives/contextual factors In the past decade in Ontario, we have seen several shifts in mental health and addictions counselling. These include: Establishment of the psychotherapy act in 2007 Establishment of mental health act 1990 Movement away from institutionalized care Expansion of community-based treatment services Recognition of addictions/mental health conditions as "disabilities" (Ontario Human Rights
Commission) Creation of multidisciplinary teams Increased focus on prevention and early intervention What are the current issues and trends in the field of addictions and mental health treatment in Ontario?
- Establishment of new college of Registered Psychotherapists of Ontario
- Development of a new addictions and mental health strategy (MHLTC) released in 2009
- Integrated, multidisciplinary treatment approaches (ACT teams)
- Court diversion programs
- Harm reduction approaches
- Effort to reduce stigma (TAMI project)
- Welcoming perspective "every door is the right door" What is the definition of a helping relationship?
- At least one of the parties has the intent of promoting the growth, development, maturity, improved functioning and improved coping with life of the other
- The counsellor/therapist/helper should have knowledge and training to assist the client in an intentional and systematic way
- We often help facilitate the process of change, rather than providing the recipe for change (client centred vs. client-directed)
- The helper has professional responsibilities, i.e. boundaries, confidentially guidelines/commitments What are the four basic goal areas for counselling?
- Behaviour/lifestyle change
- Increasing awareness or insight and understanding
- Relief from suffering
- Changes in thoughts and self-perceptions What are the 3 phases of building a counselling relationship?
- Relationship building (basic attending, Rogerian counselling, MI)
- Challenging the client to find ways to change (MI, higher order/advanced counselling skills)
- Facilitating positive client action (CBT, solution-focused, RPT, BT)
What are characteristics of a good helping relationship?
- Safe/protective atmosphere for clients
- Collaborative
- Mutual feelings of warmth, caring, affirmation, respect
- Client can identify with counsellor (role model?)
- Mutual determination of goals and procedures
- Counselling is viewed as a shared endeavour which has a likely positive outcome What are the common traits of Miller's 'super-shrinks'?
- Open to feedback from clients about what is working
- Flexible (not dogmatic) about treatment strategies (not one size fits all, not overly focused on what 'should' work, not rigid about diagnosis)
- Very focused on and committed to outcomes (even if this means referring to someone else) What are the common themes in Miller's work?
- The important of being an 'eclectic' practitioner in order to be capable of aligning with the client's theory of change
- The importance of attending to the therapeutic relationship in a direct way by constantly 'checking in' about the state of the relationship
- The dangers of thinking/believing that there are 'one size fits all' solutions to client 'problems' Define the term transference?
- "when a client reacts to the therapist as s/he did to an earlier significant other"
- The patients makes assumptions about the therapist's likes and dislikes, attitude toward the patient, life outside the office, and so forth
- We all distort our experiences in the presence due to the transference of what we 'learned' from past experiences/relationship
- Meaning that the client transfers onto the therapist the old patterns and repetitions
- Keep a mental note of potential transference reactions Who introduced transference? Freud. He believed that if the therapist took a 'detached stance', the client would 'transfer' their feelings and beliefs about others onto the therapists. He first developed the theory that we develop
emotional and behavioural patterns in our early relationships and tend to apply these to subsequent, similar relationships (i.e. gender, authority, peers, etc.) (he called these templates). Freud felt that 'analysis of transference' was essential and as such, more traditional forms of psychoanalysis use this as one of the key components of therapy Define counter-transference
- The reaction of the therapist toward the client that may interfere with objectivity
- Not always detrimental to the therapeutic goals; can provide important means of understanding your client's world
- Countertransference reactions must be monitored so that they are used to promote understanding of the client and the therapeutic process (rather than taking them at 'face value')
- All of the therapists feelings and attitudes towards the client What are the 4 general forms of counter transference?
- Realistic responses (somebody is aggressive and threatening so you feel slightly cautious)
- Responses to the client's transference (the client flatters you so you feel exceptional)
- Responses to material troubling to the therapist (client talks about jealously and you feel anxious because of concerns about infidelity in your own relationship)
- Characteristic responses of the therapist (you lack confidence about your ability to help a client, but you generally lack confidence in your abilities in all areas of your life) What are the 2 types of counter transference?
- Useful countertransference: is the feelings and attitudes that an alert therapists succeeds in employing to the client's advantage by continuing to observe and ponder them until they become empathic. This type of countertransference typically helps us to better understand and/or empathize with our client
- Obstructive countertransference: interferes with the therapist's clarity and empathy. Thus, it either creates unnecessarily negative feelings or attitudes towards the client and/or distorts how we view the client What are the ways counter transference can be obstructive?
- It can lead to avoiding or over-focusing on specific area of exploration because of our needs and/or it can cause us to use our clients for vicarious gratification
- We may emit subtle cues which influence the client to behave in certain ways, or focus on/avoid
certain areas of exploration in order to meet our needs
- We may suggest treatment/interventions which are not in the client's best interest
- We may 'fall for' the client's transference reactions and adopt the roles the clients are pulling us towards What are the ways counter transference can be useful?
- It is likely only useful if it is unique to the client (as opposed to a feeling that is very common)
- It is essential to be aware of feelings which may be countertransference
- Once aware of counter-transference feelings, maintain an 'optimal distance' from them - don't ignore or repress them, but don't let them take over
- We want our feelings for the client to be our servants, not out masters What are the professional responsibilities of being a counsellor/therapist? Law: agreed on rules for all society, designed to protect individuals and create safe communities (public safety, health & welfare) , and includes legislative, constitutional and case/tort law Mandatory ethics: professional 'rules' which are influenced and shaped by the law Aspirational ethics: 'rules' based more on concepts such as personal dignity, human rights and justice What are the 6 primary principles outlined in the Code of Ethics for psychotherapists?
- Beneficence (promote health/well-being)
- Non-maleficence (do no harm/prevent harm)
- Autonomy (respect independence/self-determination)
- Justice (promote fairness/equity)
- Fidelity (be responsible/honour agreements)
- Veracity (be truthful and honest) What are the CRPO code of ethics?
- Autonomy & dignity of all persons
- Excellence in professional practice
- Integrity
- Justice
- Responsible citizenship
- Responsible research
- Support for colleagues
What is the concept of 'competence' as it relates to psychotherapy?
- Involves practising within one's area of training and expertise, i.e. co-morbidity, special populations
- Limit services within one's skill and knowledge base
- Suspend/terminate services when client needs extend beyond one's area of competence; refer client to appropriate services
- Increase competence through further education and training
- Professional competence is not a final product, but a continuous process for the duration of one's care
- Keep current through continuing education and participation in personal and professional development activities
- Be open to seeking personal counselling if you recognize problems that could impair your ability to facilitate a group
- Be willing to seek consolation and supervision as needed Define boundary issues Boundary issues mostly refer to the therapist's self-disclosure, touch, exchange of gifts, bartering and fees, length and location of sessions and contact outside the office Define boundary crossing In psychotherapy is an elusive term and refers to any deviation from traditional analytic and risk management practices (the 'neutral' term, and opposed to boundary violations). Boundary crossings can be good, bad, neutral. (theoretical orientation, size of local community, therapist gender/ client gender, cultural norms, and therapists beliefs and motivations). Examples include: self-disclosure, dual relationships, bartering, non-sexual touch, meeting clients outside the therapy office, receiving gifts, giving 'extra time' to clients, attending 'special events' like graduations. What are the 7 things to consider when boundary crossing?
- Imagine the best possible outcome and worst possible outcome
- Explore the research literature on the type of boundary crossing
- Consult professional ethical guidelines (+ case law)
- Consult with at least one colleague whom you trust for honest feedback
- Pay attention to 'any uneasy feelings, doubts or confusions'
- Note any potential boundary crossings that are part of your style of therapy during the informed
consent process
- Keep careful, through notes about any boundary crossing, including clinical rational What is cultural competence?
- Clinical caseloads in Canada are characterized by diversity with regards to age, culture, race, gender, and sexual orientation
- Experiences of ethnic minorities and new immigrant populations in psychotherapy
- Diversity-informed psychotherapy
- Possible factors include: lack of trust in the value of the experience, feeling objectified or dehumanized, not having strengths acknowledged, feeling misunderstood due to language barriers, different body language, barriers to accessing services, and fear of stigma What is the respectful model?
- Religious/spiritual identity
- Economic class background
- Sexual identity
- Psychological maturity
- Ethnic-cultural-racial identity
- Chronological development challenges
- Trauma and other threats to one's well-being
- Family history and dynamics
- Unique physical characteristics
- Location of residence and language differences What are the 3 main concepts in cultural competence?
- an awareness of one's cultural values and biases
- cultural awareness of your client's worldview
- Culturally appropriate counselling practices What is cultural encapsulation?
- Defining reality according to one set of cultural assumptions and stereotypes
- Becoming insensitive to cultural variations among individuals
- Assuming that one's personal view is the only real or legitimate one
- Embracing unreasoned assumptions that one accepts without proof
What is included in 'culture'? Gender, sexual orientation, race, ethnicity, martial status, spirituality/ religion, language, socioeconomic status, ability, and age What are some issues of not knowing one's own cultural competence?
- Imposing one's own values on others without consideration for how these may conflict with others' culture (and how it may impact their relationship with other members of the culture)
- Knowingly or unknowingly ignoring or rejecting client values or behaviours which differ from your own
- Not acknowledging/taking for granted one's power and privilege based on cultural affiliation
- Inability to acknowledge institutional barriers faced by some clients What are 7 key elements to consider when working with a cross-cultural client?
- World view
- Personal priorities, values, and beliefs
- Individualistic or collectivist identity emphasis
- Verbal and emotional expressiveness
- Style of communication
- Possible language issues/misunderstandings
- Relationship expectations What are the parameters of client confidentiality in counselling?
- One legal imperative in our profession is the client's right to privileged communication
- Privileged communication means clients have control over who has access to what they have said in therapy
- Increases the client's sense of trust, allows him/her to share information freely with their counsellor
- Prevents therapeutic information from falling into hands of 'third parties', including employers, courts, other helping professionals When are the instances that a therapist/counsellor would break client confidentiality?
- Circle of care
- Child abuse, including emotional abuse
- Neglect/failure to provide basic needs
- Legal subpoena
- Risk of harm to self/other
- Sexual abuse by a regulated health professional
- Conditions which pose an imminent health risk to others, i.e. HIV transmission What do you do if you break confidentiality?
- Involve/consult with a third party
- Be transparent
- Document client information
- Document ongoing development • What are the necessary elements involved with informed consent?
- Competence (client must be able to make competent decision and cannot be a minor)
- Informed (client must be given relevant information about the 'procedure' in a language they understand)
- Voluntary (client must give consent freely-no coercion)
- Documented ( consent must be appropriately documented (written or oral) What information must you provide prospective clients in order for them to give informed consent?
- Confidentially and the limits of confidentiality
- The nature of the therapy process
- Risks and benefits of therapy
- Their access to information rights
- What they can expect from you as a counsellor/therapist
- Client rights and responsibilities
- Billing information (if applicable) What are the major functions of the various attending and listening skills in the basic listening of sequence?
- Attending behaviours include any behaviour which communicates to a person that your full attention is on their verbal and non-verbal communication
- Helps clients to: reflex and be more comfortable, feel responsible by enabling him to direct the
session , trust the counsellor
- Encourages client to: continue to express ideas and feelings freely, and explore ideas and feelings in his/her own way
- Enables counsellor to: obtain more accurate inferences about the client through careful observation What is the solar technique? s- sit squarely facing the client o-observe an open posture l- lean forward toward the client E-establish eye contact R-relax What is the basic listening sequence?
- Ivey and Ivey (2007) suggest that there are serval core listening 'skills' which are incorporated across different theories of counselling and psychotherapy. They refer to these skills as 'the basic listening sequence'
- Skills that comprise the BLS need not to be used in any specific order
- Skills are adapted to meet the needs of the client, the situation and/or the guiding theory
- Flexibility is key
- Vocal tone: 'a caring voice that is neither hesitant nor rapid and projects inner qualities of warmth, respect and compassion for their 'client'
- Verbal tracking: listening to 'relevant' aspect of client's narrative, using silence strategically What are the 3 parts of basic listening skills?
- Identifying key facts and thoughts about the situation
- Identifying central emotions about the situation
- Providing an verbal summary of the situation (synthesize facts, thoughts, and feelings, and check for accuracy) What are the 5 key skills of the basic listening sequence? Five key skills in the basic listening sequence:
- Open/closed questions (better understand what the client is describing)
- Encouragers (encouragers include actions such as head nods and facial expressions or verbal cues
such as 'mmhm', 'uh huh', 'ok', etc.)
- Paraphrases (paraphrase's involve feeding or reflecting back the essence of content of what the client has shared)
- Reflection of feeling (reflecting the emotion or affect behind the client's words)
- Summarization (similar to paraphrasing, summaries capture the essence of a longer period of conversation) What is an open-ended question?
- Usually begin with what, how, could or would
- Require a longer, more detailed response
- Used to encourage clients to express more information/more depth/ more detail What is a closed-end question?
- Usually begins with is, are, do or did
- Used to gather information, gain clarity or create focus
- Can feel interrogative Describe the 'skilled helper model' for structuring counselling sessions? Stage one - the current picture ('what's going on") Stage two - the preferred picture ('what do I need or want") Stage three- the way forward ('How do I get what I need or want?") The action arrow ('making it happen') Describe stage one of the skilled helper model?
- As counsellor, your initial task is to get a sense of what the client's problems, issues or concerns are
- You are helping the client to 'tell their story'
- You are responding to the story in a way that lets the student know you empathize/understand
- You provide feedback/reflection and/or ask questions which help you, and perhaps even the client, to better understand their story
- It is important to note that there is certain information that you will have to collect/get details about, as they must be included in your clinical notes: mental health symptoms - if a person alludes to mental health issues such as depression or anxiety, you should probe for specific symptoms, substance use - if a person mentioned that they struggle with substance use (or that others are
concerned), you should attempt to find out what they are using, how often and 'how' and suicidality- if a person mentions and they struggle with suicidal thoughts, you need to explore this in more detail Describe stage 2 of the skilled helper model
- As a counsellor, an important task is not let the session be 'problem saturated', but to help the client to explore desired outcomes
- This will come easily to some clients, while others may struggle and need to provide direction (some clients want others to change)
- Part of the counsellor's role I this stage is to help the client to create relevant and realistic goals which they are motivated to attain Describe Stage 3 of the skilled helper model
- As a counsellor, part of our role is to help clients get a sense of what they need to do to attain their goal
- Important that proposed strategies 'fit' the clients sense of what they value and what they can do: sometimes based in the best practices (i.e. CBT, RP), sometimes co-created by client and counsellor
- Often involves 'homework' or tasks to complete/attempt between sessions Describe the Action Arrow in the skilled helper model
- Much of your ability to be effective in any stage of the counselling relationship will be based on the quality of your report/attunement with the person with whom you are working
- It will also be important for you to directly or indirectly help the client to feel inspired, empowered and at 'the centre of the change process' in order for them to maintain motivation
- The client need to trust you-both as a person and as an 'expert'