Exam Questions Flashcards
(60 cards)
1
Q
What are 3 professional micro skills in counselling and why use them?
A
Summarising Reflecting Paraphrasing
2
Q
Give an example of how 3 micro skills can be done well and badly
A
Summarising - : Good; Said at a good time; Reflects both affect components, events and what appears to be important to the client. Bad: interrupting client; way off topic; talking over client;own agenda Reflecting; Good: Gentle reflection of feeling on topic; Bad: interrupting; totally off topic; telling them what you think Paraphrasing - Good; indicate you are following; indicate keep going; timing Bad: Interrupting; talking over clients; off topic
3
Q
Describe Six Ways of Building Rapport
A
- Warm greeting- helps client feel welcomed 2. Use clients name 3. Proximity seating 45 degree angle 4. Showing Empathy 5. Open relaxed body language 6. Appropriate eye contact
4
Q
Give 2 examples of session structure that are important
A
Informed Consent
Taking history
Set the agenda with client (no surprises)
Review the homework
A Specific technique (have time for it)
Discuss homework and next week
5
Q
What are the three goals of verbal responding?
What do you need to communicate?
A
- You have heard and understood their perspective/feelings
- Your empathy, acceptance, respect and caring for them as a client
-
Increase the client’s self understanding by;
- focusing on major themes
- clarifying inconsistencies
- reflecting underlying feelings
- summarising major affective and cognitive concerns
6
Q
Describe three of the techniques you would use to build Empathy with a client
A
Empathy is shown through;
Communication: the capacity to listen, pay attention, perceive and respond in a way that the fore-mentioned are obvious i.e., you have paid attention, perceived and responded appropriately, verbally and non-verbally
1. Summarizing
2.Paraphrasing
3. Reflecting
7
Q
Describe the overall factor structure of the WAIS - IV
A
1. Verbal comprehension Index
2. Perceptual Reasoning Index
3. Working memory Index
4. Processing Speed Index
8
Q
What are the Core and Supplemental Areas tested under Verbal Comprehension?
A
Verbal Comprehension:
Core;
- Similarities
- Vocabulary
- General Knowledge
Supplemental; Comprehension
9
Q
What are the Core and Supplemental Areas tested under Perceptual Reasoning?
A
Perceptual Reasoning
Core;
- Block design;
- Matrix;
- Visual Puzzels
Supplemental; Pic Comprehension ; * Figure Weights
10
Q
What are the Core and Supplemental Areas tested under Working Memory?
A
Working Memory;
Core;
- Digit Span; 123456767899
- Arithmetic (1+1=2)
Supplemental; Letter Number Sequence (Happy123)
11
Q
What are the Core and Supplemental Areas tested under Processing Speed?
A
Processing Speed;
Core;
- Coding
- Clerical typing speed ;
- Symbol Search
- Speed of visual search
Supplemental;
- Cancellation - Measures;
- Speed of visual discrimination
12
Q
What would it mean if someone had a difficulty/deficit in verbal comprehension?
A
- difficulty understanding instructions;
- slower to respond and
- appear to have other difficulties or
- seem defiant etc behaviour issues
13
Q
What are the strengths of the WAIS- IV?
A
- Normative data
- Rigorous Standardisation
- Good reliability
- Stable IQ and Index Scores
- Co-Linking with other tests (e.g. WIAT)
- Well-known
14
Q
What are the weaknesses of the WAIS - IV
A
- Concern not well linked theoretical understanding of intelligence
- Can be easy to ‘over-interpret’, particularly individual subtests
- Missing thorough exploration of executive functioning, personality, social intelligence
- Danger in labeling a child with one number: the “IQ”
- Limited application
- Use of IQ cut-offs for services and funding
- Functional abilities
15
Q
What is the Mean and SD on for the Full Scale IQ (FSIQ)
A
Mean = 100 SD = 15
16
Q
what if the Index scores are too far apart? What does this mean?
A
If there is a discrepancy between the index scores and it is more that 1.5 SD (23 points) from the other scores then the FSIQ lacks integrity
17
Q
What are the 9 areas of History Taking?
A
- Presenting Problem 2. Family & Developmental History 3. Educational 4. Occupational 5. Health & treatment 6. Relationship history 7. Social 8. Substance use history 9. Forensic
18
Q
Why ask about history?
A
Because it give you a good idea of what the problems are, were they may have come from and what you may be needing to deal with in treatment and to help develop a treatment plan
19
Q
Family & Developmental History Question
A
- May I ask you a few questions about your childhood? 2. Where were you born? 3. Where did you grow up? 4. Did you have any serious illnesses as a young child? 5. As far as you know, did you walk and talk at the appropriate age? 6. Do you remember any significant events between the age of: 0-6?; 7-12?; 13-18?
20
Q
Occupational History Questions
A
What sort of work do you do now? Where do you work? How long have you been there? Are you enjoying it? What did you do prior to that…for how long…then what happened?
21
Q
Social History
A
Are you married/in a relationship? How long How would you describe your marriage/relationship? Do you have any children? How old are they? How would you describe your relationship with your children? Who lives at home with you at the moment?
22
Q
What is the MSE and how can it be used
A
A summary of the clinicians observations and impressions of the client at the time of the interview. It can be highly descriptive and allow another clinician to develop a good impression of the client without being there. Can be used as a clinical measure of change over the course of treatment (though has subjectivity). There are some variations as to the components, Included hereafter are those most typical of an MSE.
23
Q
Appearance
A
Apparent age Height Weight Dress – nonjudgmental descriptive terms Self-care/grooming – consider their hair, hygiene level, make-up, overall self-presentation Prominent characteristics Ethnicity
24
Q
Speech
A
Quality - volume, pitch/tone (e.g., highness or lowness) clarity Quantity - Rate Other speech abnormalities E.g., Witzelsucht; Poverty of Speech Note if client has hearing aid, or other indication of hearing problems
25
What are the areas assessed in the MSE
Appearance Behaviour Speech Mood Affect Perceptions Cognition Thought Judgement Insight
26
Using appropriate terminology outline 3 aspects of a client's speech that you would be observing when undertaking a MSE.
For each aspect, indicate the term used and what it might indicate about their mental state.
Rate, Flow, Volume, Pitch
**Quality** - volume, pitch/tone (e.g., highness or lowness) clarity
**Quantity** - Rate Other speech abnormalities E.g., Witzelsucht; Poverty of Speech **Note if client has hearing aid**, or other indication of hearing problems
Could also indicate other abnormalities ie translating from second language, cultural or perhaps hearing voices etc
27
What are the elements of the Beutler Model **Coping Style?**
**A continuum**
Externalising -------------------------- Internalising
**“Externalisers” are people who generally:**
* Blame others, events, bad luck, fate
* Actively try to avoid their problems
* More impulsive, manipulative, aggression risk
**“Internalisers” are people who generally:**
* Blame themselves – perceive poor skills/abilities
* Seek understanding and answers (risk of intellectualising)
* Constrict, repress, minimise, control
28
What is the Beutler Model of Treatment Selection?
* Based on identification of r**elevant client characteristics**
* L**inks approach to characteristics** with evidence-based research.
* **6 client dimensions**
* Functional Impairment; Social Support; Problem complexity/chronicity; Coping style; Resistance; Subjective distress
* **Additional Problem-solving phase (based on stages of change)**
29
What are the 6 Client Dimensions of the Beutler Treatment Model?
1. **F**unctional Impariment
2. **S**ocial Support
3. **P**roblem complexity/chronicity
4. **C**oping style
5. **R**esistance
6. **S**ubjective distress
30
How does the current DSM-V rate current functioning?
Using the WHODAS
31
Beutler Model Resistance ...what is it all about?
* A defence against a perceived loss of control
* High resistance can result in person acting in opposite ways to that recommended
* Which can therefore increase symptoms and dysfunction
* Low resistance does not equal submissive
32
What are the treatment approaches to **Resistance** high level and low level?
**High Resistance**
* Supportive approach
* Self-directed interventions (e.g., self-monitoring)
* Paradoxical techniques (e.g., symptoms exaggeration, prescribing no change)
**Low Resistance**
* Directive & Structured approach
* Multiple therapeutic interventions (e.g., CBT)
33
What is Subjective Distress in the Beutler Model?
* Degree to which client experiences their problems
* Differs from ‘Functional Impairment’
* ‘Functional Impairment’ is more objective
* Subjective distress can be reactive to environmental events
* e.g., might feel a decrease in distress upon receiving some flowers; but this wouldn’t change their functional impairment
* Distress can change within each session
34
What are the high and Low qualities of Subjective Distress?
**High distress looks like:**
* High emotional expression
* Hyperventilation
* Motor agitation
* Poor concentration
* Hypervigilance
**Low distress looks like:**
* Poor emotional investment in treatment
* Low energy
* Constricted/blunted affect
* Slow speech, monotone
35
Subjective Distress and it's relationship to therapy
**High distress can be disruptive on therapy**
* Difficulty processing information
**Low distress can be disruptive on therapy**
* Difficulty becoming engaged
**Moderate distress can be useful**
* Not too overwhelmed
* Motivates engagement in therapy
* More able to concentrate and perform interventions
36
What are the 5 stages of change?
**Pre-contemplation** – no intention of changing his or her behaviour. Many individuals in this stage are not even aware they have a problem.
**Contemplation** - aware that a problem exists and are thinking about it but have not yet made a commitment to take action.
**Preparation** - intend to change their behaviour but may not yet have begun to do so. This may be due to unsuccessful attempts in the past, or they may be delaying action until they get through a certain event/stressful period of time.
**Action -** where the individual modifies their behaviour to overcome the problem.
**Maintenance** - Been able to remain free of the behaviour for more than 6 months. Work to prevent relapse and consolidate the gains they have made.
37
What is the Beutler treatment approach to the
## Footnote
**Problem Solving Phase?**
**Precontemplation stage**
* Building rapport; highlighting areas of life dissatisfaction
**Contemplation & Preparation stage**
* Explore interpersonal/behavioural patterns, pros & cons for changing, clarify life values and goals, explore possible strategies to change
**Action stage**
* Specific and concreate therapeutic techniques (e.g., CBT)
**Maintenance stage**
* Relapse prevention
* Social supports
* List of strengths, coping strategies
38
Outline a Simple Session Agenda
1. Review & Update with client the past week
2. Review weekly task (i.e., homework)
3. Collaboratively agree on content of session
4. Conduct main session content (based on treatment plan)
5. Summarise session (inc. what client has learnt)
6. Assign new weekly task
7. Final check-in (questions, concerns, other issues to discuss)
39
Outline FOUR factors you might take into consideration when planning a client's psychological treatment
1. **Functional Impairment** - High/Low Hospitalisation or Outpatient
2. **Chronicity/Complexity** - Longer term treatment v's argeting specidfic symptoms
3. **Social Supports** - High /Low whether group or individual
4. **Coping Style**-Externaliser/Internaliser
5. **Resistance** -High or Low depends on whether self directed or structured treatment
6. **Subjective Stress** - reduce or increase will affect motivation to participate in therapy
40
Describe FOUR organisational elements that most diagnoses listed in DSM-V include;
Each disorder has a set of criteria (A, B, C D etc.)
**The criteria typically cover**
* ### **Time frame** (course and trajectory)
* ### **Qualifying symptoms**
* ### **Disqualifying symptoms**
* ### **Differential diagnosis (parsimony)**
* ### **Severity (disability)**
* ### **Social and Occupational disturbance**
* ### **\*\*Not better explained by a Medical condition**
41
Describe the alternative framework for assessing the presence of personality disorder contained in section III of the DSM - 5;
**6 Personality Disorders** **include;**
## Footnote
* **A**ntisocial/Psychopathic Type;
* **A**voidant Type;
* **N**arcissistic Type;
* **O**bsessive-Compulsive Type;
* **S**chizotypal Type; and
* **B**orderline Type.
**Core Criteria**
Moderate + Disturbances in ;
* **Self** (Identity & Self-direction) functioning
* **Interpersonal** (Empathy & Intimacy) functioning
**Meets criteria for relevant pathological traits**
**5 broad domains –**
* **N**egative Affectivity
* **D**etachment
* **A**ntagonism
* **D**isinhibition and
* **P**sychoticism
Each of these trait domains is comprised of a number of trait facets
42
What are the strengths an limitations of using of using diagnosis with clients requiring psychological therapy?
**Strengths**
* help orient to evidence based interventions;
* help access service access or funding;
* helps client to feel like having a name is reassuring;
* forensic could be both;
* communication between practitioners easier
**Limitations**
* Feel Stigmatised;
* Labelled; e.g. travel insurance incompatible; assumes people present or suffer in the same
* Diagnosis is only the what not the why....can detract from the understanding of the individual
43
What are the core differences between DSM - IV and DSM -5
1. Axial Assessment (Axis I - V)
2. Assessment of functioning (GAF) Axis V
3. Doesn't have the Alternative method for diagnosing PD
44
Why introduce the alternative personality approach?
Becasue there are too many disorders that have overlapping criteria which make it difficult for diagnosis and treatment planning.
45
What is the alternative PD assessement based on in the DSM -V?
Personality disorders are characterised by;
**Impairments** **in personality functioning** and
**Pathological personality traits.**
This approach also includes a diagnosis of;
**Personality Disorder - Trait Specified (PD-TS)**
that can be made when a personality disorder is considered present but the criteria for a specified disorder is not met.
46
What is ther WHODAS and what does ICF stand for;
Likewise, the WHO **Disability Assessment Schedule (**WHODAS), a
standard method for assessing global disability levels for mental disorders that is based on the **I**nternational **C**lassification of Functioning, Disability and Health (ICF) and is applicable in all of medicine, has been provided to **replace the more limited Global Assessment of Functioning scale**
47
Taking one psychological disorder as an example; outline the structure typically used within DSM-V to assess and diagnose a mental disorder
**Each disorder has a set of criteria (A, B, C D etc.)**
**Social Anxiety Disorder (Social Phobia)**
**Qualifying Symptoms**
**A. Marked fear or anxiety about one or more social situation in which the individual is exposed to possible scrutiny by others.**
**B. The individual fears that he or she will act in a way that will be negatively evaluated** (i.e. humiliating and lead to rejection)
**C. The social situations almost always provoke anxiety**.
**D. The social situations are avoided or endured with intense fear and anxiety**
**E. the fear or anxiety is out of proportion to the actual threat posed by the social situation and sociocultural context**
**F. Fear & Anxiety is persistent and generally lasts for 6 months or more (Time)**
**G. Fear & Anxiety causes clinincally significant distress or imapirment in social; occupational; and other important areas of functioning**
H. Effects are **not attributable to substance abuse**
**Differential Diagnosis**
I. Fear is **not better explained by symptoms of another disorder** ; e.g. panic disorder, body dysmophic disorder; autism spectrum disorder
**J. If another medical condition is present**
**Specifiy if;** Performance only - fear is restricted to speaking or performing in public
* Time frame (course and trajectory)
* Qualifying symptoms
* Disqualifying symptoms
* Differential diagnosis (parsimony)
* Severity (disability)
* Social and Occupational disturbance
* Not better explained by a medical condition
Additional Sections;
* Specifiers
* Diagnostic Features
* Associated Features Supporting Diagnosis
* Prevalence
* Development & Course
* Risk & Prognostic Factors
* Culture Related Diagnostic issues
* Gender Related Diagnostic Issues
* Functional Consequences of Social Anxiety Disorder
* Differential Diagnosis
* Comorbidity
48
Describe FOUR short term risk factors and FOUR long term risk factors;
**Short Term:**
1. **Current Suicidality** - thoughts, plan, intent -when?
2. **Recent Stresors** - Job loss, personal prob, work prob
3. **Acute Mental or Phsyical Illness** - Hopelessness, Helplessness, Despair
**Long Term;**
1. **Personal History of:** previous suicide attempts (note lethality of attempts); self-harm
2. **Family History of:** Suicide attempts/completions; Psychiatric illness
3. **Long-term problems:**
* Interpersonal (History of Divorced/widowed/single)
* Unemployed/retired
* Physical illness
* Psychiatric illness (especially inpatient care)
* Personality disorder / Personality Structure
1. **Forensic history**
2. **Substance abuse**
3. **Problem solving ability (inc. Impulsivity)**
4. **Male gender**
49
What is the Risk Equation/Model?
The Risk Equation is a template made up of 4 components:
1. Long term risk;
2. Short term risk;
3. Hazards; and
4. Protective factors.
50
Describe THREE factors you would take into consideration when assessing for imminent risk of suicidal behaviour?
1. **Past attempts**
**2. Means**
3. Plan/Imminence
**4. talking about death**
**5. Dramatic mood changes**
**6. Risky Behaviours**
**7. Giving away posessions**
**8. Hopelessness**
51
You are asked by a local radio station to comment on air about the relationship between media reporting and suicide. What 3 key points would you choose to address?
In the past there has been instances where media reporting has influenced the rates of suicide so it is essential that (South Korean Reporting);
* **Method and location** should not be reported
* **Should not sensationalise,** glamorise or trivialise or stigmatise
* Reporting **should not be given undue prominence**, and done so in moderation
* **Published material should be accompanied by information regarding appropriate 24-hour support**
* **Avoid the use of derogatory terminology**
* Avoid inferring that people with mental illness are violent, unable to work, are weak or are unable to recover
52
When would you call the Police in the matter of suicide risk?
If the client could not promise to keep safe
If the client was clearly a risk; means; plan; past threat
53
HEADS Model of Risk Assessment for Young People;
What does Heads Stand For?
**H: Home and health**
**E: Education and employment**
**A:** Activities, ambition and affect
**D: Disease and drugs**
**S: Suicide**
54
What are some of the goals of Crisis Intervention?
There are some clear goals to managing crisis situations. These goals include:
* to calm the person
* to reduce the immediate risk of suicide (prevent/limit access to means; supportive networks in the person’s life)
* to reduce the threat to others who may be involved (particularly children)
* to enhance hope and confidence (ensure the person knows how your service/ other services can help)
* to improve effectiveness in tackling problems
* to arrange treatment of mental disorder/illness.
55
The National Law identifies Impairment as a source of notifiable conduct. Summarise TWO possible sources of impairment.
The National Law requires all psychologists to make a notification to AHPRA if they form the reasonable belief that a psychologist has, during the course of their practice:
* Practiced whilst intoxicated
* Engaged in sexual misconduct
* Placed the public at risk of substantial harm due to an impairment
* Placed the public at risk due to practice that is a significant departure form accepted standards
56
Identify FOUR of the signs of stress in yourself that you recognise may be a warning that you are approaching burnout.
Feeling Irritable
Feeling Constantly Exhausted
Grinding My teeth a night
Trouble Sleeping
Not looking after myself
Over eating - sweet foods, comfort foods
Binge watching television ... a lot
57
What are THREE of the common causes of burnout in professional psychologists?
Perfectionism
Overworking
Lack of Self Care
Ethical Distress
Career Conflict (not n the right job)
Vicarious Trauma
Compassion Fatigue
58
What does the National Law say about impairment?
1. A physical or mental impairment, disability, condition or disorder
2. That detrimentally affects the persons capacity to practice the profession
3. And in so doing places the public at risk of substantial harm
59
Self Care Tips for Sessions
**Before sessions**
* Allow time between clients so you’re not rushing
* Quick relaxation before hand
* Check in on your emotions – are you in a good emotional place? Are you able to therapise well?
**During and after a challenging session**
* Notice your reaction
* Practice simple breathing to stay calm
* Focus on the client, here and now
* Reflect afterwards – why was this challenging? Don’t ignore reactions (e.g. frustration)
* Pause, before seeking help
**Practically – around sessions generally**
* Eat regularly and drink lots of water
* Leave work at the front door
* Reflect on what you did well
60
Using a specific neurological test as an example, describe 3 limitations of each test. For each one suggest a way in which the limitation can be overcome
* Concern **NOT** well linked **THEORETCAL understanding of intelligence**
* Can be **easy to ‘OVER INTERPRET’,** particularly individual subtests
* **MISSING thorough exploration of EXEC functioning, PERSONALITY, SOCIAL iNTELelligence**
* **Danger in LABELLING** a child with one number: the “IQ”
* **LIMITED APPLICATION**
* **Use of IQ cut-offs for services and funding**
* **FUNCTIONAL abilities**
**1. OVER INTERPRET. -** keep that in mind and perhaps do other testing too
**2. MISSING Thourough Exploration PERSONALITY - other testing**
**3. Danger in Labelling - explain in conjuction with otehr aspects of fnctioning perhaps creativity/personality as a part not the whole exploration,perhaps do observation**
