Test 2 (new content only)

Question 1

The client, not the therapist, is the expert
Dialogue is used to elicit perspective, resources, and unique client experiences
Questions empower clients to speak and to express their diverse positions
The therapist supplies optimism and the process
Goal of therapy – help client find new meaning

Answer 1

Social Constructionism

Question 2

Therapy grounded on a positive orientation—people are healthy and competent
Past is downplayed, while present and future are highlighted
Therapy is concerned with looking for what is working and going well
Therapists assist clients in finding exceptions to their problems

Answer 2

Solution-Focused Therapy

Question 3

Questions can get clients to notice when things were better
Useful questions assist people in paying attention to what they are doing and can open up possibilities for them to do something different
Effective questions focus attention on solutions

Answer 3

Solution-Focused Questions

Question 4

Types of Relationships

Answer 4

Customer-type relationship
Complainant relationship
Visitors

Question 5

Client and therapist jointly identify a problem and a solution to work toward

Answer 5

Customer-type relationship

Question 6

A client describes a problem, but is not able or willing to take an active role in constructing a solution

Answer 6

Complainant relationship

Question 7

Clients come to therapy because someone else thinks they have a problem

Answer 7

Visitors

Question 8

Pre-therapy change
Formula first session task
Exception questions
Miracle question

Answer 8

Types of Questions

Question 9

Therapists ask, “On a scale of zero to 10, where are you with respect to __________?”

Answer 9

Scaling questions

Question 10

Therapists take a short break during each session to write a summary for clients

Answer 10

Therapist feedback to clients

Question 11

begins at the first session

Answer 11

Termination

Question 12

We live our lives by the stories we tell about ourselves (internalized and externalized stories) and that others tell about us.
Our stories shape our reality.
The stories we live by grow out of conversations in a social and cultural context.
Change occurs by exploring how language is used to create and maintain problems.

Answer 12

Narrative Therapy

Question 13

Collaborate with the client in identifying (naming) the problem
Separate the person from his or her problem
Investigate how the problem has been disrupting or dominating the person
Search for exceptions to the problem
Ask clients to speculate about what kind of future they could expect from the competent person that is emerging
Create an audience to support the new story

Answer 13

Narrative Therapy - Process

Question 14

involves turning the tables by asking what clients think of the judgments they have been assigned

Answer 14

Deconstruction

Question 15

Problem-saturated stories are deconstructed before new stories are co-created
Unique possibility questions enable clients to focus on their future
An appreciative audience helps new stories to take root

Answer 15

Creating alternative stories

Question 16

Narrative therapist pioneered the use of therapeutic letter writing
Can be as effective as up to 5 sessions
Use of direct quotes from client
Carry the session content into the client’s life outside of session

Answer 16

Letter writing

Question 17

Social constructionism is congruent with the philosophy of multiculturalism
Clients are encouraged to explore how their realities are being constructed out of cultural discourse and the consequences that follow from such constructions
Narrative therapy is grounded in a sociocultural context
Clients can make significant progress in building more satisfying lives in a short time
The postmodern approaches remind us that people cannot be reduced to a specific problem
Practitioners adopt a nonpathologizing stance

Answer 17

Strengths of narrative therapy

Question 18

Adopting a “not knowing” stance may lead clients from some cultures to lose confidence in the therapist
Therapists must be skilled in implementing brief interventions
Therapists may employ techniques in a mechanistic fashion
Reliance on techniques may detract from building a therapeutic relationship
More empirical research is needed

Answer 18

Limitations of narrative therapy

Question 19

Anything that overwhelms a persons capacity to cope

Time limited

Answer 19

Crisis

Question 20

Is the employment of a variety of direct and action-orientated approaches to help individuals find resources within themselves and/or deal externally with crisis

Answer 20

Crisis counselling

Question 21

The restoration of psychological balance
The aim is coping with the immediate difficulty
A more direct approach on the part of the counsellor, psychiatric nurse is often appropriate because the person’s inner resources have gotten stuck or are paralyzed

Answer 21

Objectives of Crisis Intervention

Question 21

Steps of crisis intervention

Answer 21

1. Listen
2. Assessment
3. Develop an action plan
4. Termination

Question 21

To help the person cope effectively with the crisis situation and return to his usual level of functioning
To decrease the anxiety
To teach crisis-management techniques

Answer 21

Crisis intervention goals

Question 22

Establish rapport and trust
Identify precipitating problems
Help the person deal with, identify, and diffuse feelings
Ask direct questions
Explore underlying feelings

Answer 22

Step 1 of Crisis Counselling - Listen

Question 23

Determine the severity of the crisis Thoughts of suicide, homicide or both? Find out to what extent the crisis has disrupted the person’s regular life pattern Find out if the level of tension has distorted their perception How are they coping at present? What coping methods were used in the past? Resources? Supports?

Answer 23

Step 2 of Crisis Counselling - Assessment

Question 24

Selectively choose and use appropriate approaches to action planning Use three basic approaches: - Start by being non-directive - Be collaborative by working together on a joint plan - Be directive if the person does not or will not make a plan

Answer 24

Step 3 of Crisis Counselling - Develop an action plan

Question 25

Review completed action plan Do anticipatory planning for building new ties with resources Plan and provide follow-up provisions

Answer 25

Step 4 of Crisis Counselling - Termination

Question 26

Immediate accessibility Lack of stigma associated with this modality Clients’ may be resistant to using treatment Non-threatening Often easier to quickly establish closeness on the telephone without the distractions of physical cues – done through the voice Sense of anonymity Exclusive focus is the communication

Answer 26

Mobile crisis services

Question 27

1. Identify risk factors 2. Assessment mood symptoms (depression) 3. Explore suicidal ideation 4. Explore suicide plan 5. Determine intent 6. Assess clients level of self control 7. Develop a plan to keep the client safe

Answer 27

Suicide assessment interview

Question 28

Psychache Perturbation Adamance

Answer 28

Assessing Risk and Lethality

Question 29

sense of tension or agitation, anxiety, restlessness, psychomotor arousal

Answer 29

Perturbation

Question 29

subjective mental pain, including sadness, anger, hurt, humiliation, sense of loss, dread, etc.

Answer 29

Psychache

Question 30

steely resolve not to bow to circumstances of current adversity or accept any humiliation that may be necessary in order to deal with problems – unyielding or inflexible

Answer 30

Adamance

Question 31

- Helplessness (feelings of weakness and powerless to deal with the problems, which might include client’s illness) - Hopelessness (feeling there will be no effective rescue from the outside) - Lethality (the person has been considering violent, aggressive or potentially lethal ways of ending their problems) - Impulsivity - Resignation and acceptance of suicide equation - Ideation (e.g. command hallucinations, depression) - Alcohol or narcotic abuse problem - Primary psychiatric disorder playing major role - Lethality of plan

Answer 31

High Risk Scale

Question 32

Stoicism Adaptability and coping capacity Alternative solution- seeking Spirituality Supports

Answer 32

Protective factors

Question 33

results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being

Answer 33

Trauma

Question 34

It was unexpected. The person was unprepared. There was nothing the person could do to stop it from happening.

Answer 34

Common elements of individual trauma

Question 35

Changes to the brain Compromised immune systems Increased physical and mental stress Decreased trust Attachment difficulties and conflictual relationships Hyperarousal and hypervigilance Rigid or chaotic behaviour

Answer 35

Impacts of trauma

Question 36

Are sensitive to the ways that persons current difficulties may be related to past trauma’s Validate and normalize the client’s experiences Help clients manage distress for more effective daily functioning Develop a therapeutic relationship Empathetic Empower clients Develop client appropriate boundaries Engage in self-care and reflection

Answer 36

Trauma informed clinicians

Question 37

Often unhelpful to: Avoid discussing trauma Ask for too much detail Minimize the aspect that trauma has had on the persons life Do not: Conduct trauma therapy if not trained to do so

Answer 37

Trauma informed clinicians

Question 37

1. Safety 2. Trustworthiness and Transparency 3. Peer Support 4. Collaboration and Mutuality 5. Empowerment, Voice and Choice 6. Cultural, Historical, and Gender Issues

Answer 37

Key principles of trauma informed approach

Question 37

Build relationships based on respect, trust and safety. Use a strengths-based perspective. Frame the client’s coping behaviours as ways to survive, and explore alternative ways to cope as part of the recovery process. Respond to disclosure with belief and validation that will inform practical issues related to care. Help the client regulate difficult emotions. Acknowledge that what happened to the client was bad, but that the client is not a bad person. Recognize that the client had no control over what happened to them. Provide an appropriate and knowledgeable response to the client that addresses any concerns they may have about the services offered to them, and then use this knowledge to guide service delivery. Watch for and try to reduce triggers and trauma reactions.

Answer 37

Trauma informed practice standards

Question 37

the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured.

Answer 37

Vicarious trauma

Question 37

Provides a new paradigm that views trauma as an injury. The shift from “what is wrong with you?” to “What has happened to you?” Understands freeze, flight and fight as survival responses. Recognizes that trauma is pervasive.

Answer 37

Being trauma informed

Question 38

Feeling stuck in some part of body Feeling cold/frozen, numb, pale skin Sense of stiffness, heaviness Holding breath/restricted breathing Sense of dread, heart pounding Decreased heart rate (can sometimes increase) Orientation to threat

Answer 38

Fight, flight freeze

Question 38

Are protective measures that help to ensure the psychological safety of the clinician while maintaining boundaries in the therapeutic relationship

Answer 38

Self care and reflection

Question 38

Realizes Recognizes Responds Resists re-traumatization

Answer 38

4 R's of trauma informed approach

Question 38

Empathy and Compassion Able to talk openly Self-awareness Self-care and wellness Flexible Comfortable with the unknown Willingness to learn from clients Willingness to connect emotionally with the client’s experience of trauma Willingness to step into the world of the client Able to regulate own emotions

Answer 38

Trauma informed clinician characteristics

Question 38

Pre-therapy change Formula first session task Exception questions Miracle question Scaling questions Therapist feedback to clients Terminating

Answer 38

Solution focused therapy techniques

Question 39

Step 1: Client narrates her/his preferred story of a significant life event or experience, with guidance from the therapist, and with the outsider witness as the audience. Step 2: The outsider witness is asked to respond to what was just said. The therapist asks questions of the outsider witness to elicit their response in each of these four areas: expression, images, resonance, and transport. Step 3: Client re-tells the story once more, this time with special emphasis on the expressions, images, resonance, and transport that the outsider witness brought to light. Step 4: The therapist, client, and outsider witness reflect on the original story, the outsider witness response, and the re-telling of the story, discussing the therapeutic processes that took place.

Answer 39

Narrative: Alternate Story - Outsider Witnessing

Question 40

Understanding what it means to be human Sets to understand the balance of the limits and opportunities of human life Our existence is never fixed Philosophical approach

Answer 40

Existential therapy

Question 41

The capacity for self-awareness Freedom and responsibility Striving for identity and relationships Searching for meaning Anxiety as a living condition Awareness of death and nonbeing

Answer 41

Existential therapy - dimensions of human beings

Question 42

Multicultural perspectives Can be adapted to brief therapy Emphasis on the quality of relationships Emphasis on freedom and responsibility

Answer 42

Existential therapy strengths

Question 43

Help to increase clients levels of awareness of self and the nature of their problems Aimed at understanding the client’s experience Development of the therapeutic relationship

Answer 43

Existential - therapist role

Question 44

Does not take into account social factors or environmental circumstances Highly philosophical Not an overly structured approach Not effective in trauma or crisis

Answer 44

Existential limitations

Question 45

An existential and holistic approach Goal is to expand clients awareness regarding how they function in life Clients are experts and direct therapy Focuses on clients perceptions of reality and what is taking place in the present Affirms the capacity for growth and change Values self-discovery and self-acceptance Therapeutic relationship is collaborative

Answer 45

Gestalt therapy

Question 46

Active partnership Pay attention to clients verbal and non-verbal language Listens to clients use of metaphors and explores the metaphor Uncovers client’s stories

Answer 46

Gestalt therapy - therapist

Question 46

1. The empty chair 2. Future projection 3. Exaggeration exercise 4. Staying with a feeling

Answer 46

Gestalt - interventions

Question 47

Appropriate to use for diverse range of clients Effective at treating a variety of psychological disorders, personality disturbances, psychosomatic problems and substance abuse Holistic

Answer 47

Gestalt strengths

Question 48

Little attention is paid to cognitive processes Requires in-depth training and strong clinical background is required to strongly master technique

Answer 48

Gestalt limiations

Question 48

No single individual can be identified as the founder of this approach, reflecting a central theme of feminist collaboration The beginnings of feminism (the first wave) can be traced to the late 1800s The women’s movement of the 1960s (the second wave) laid the foundation for the development of feminist therapy Feminist theory and movements are continually evolving

Answer 48

Feminist therapy history

Question 49

Racial inequality was a factor that was largely ignored by first-wave feminism (and even used regarding the suffrage movement), which was primarily concerned with gaining political equality between men and women. Though at the same time, there were abolitionist feminists (both women of colour and white women). Vote, education, employment, right to own property

Answer 49

What became known as “First Wave feminism”

Question 50

usually referring to feminism of the 60’s -1980’s – not just political equality (fought by first wave), but social equality – pay gap, birth control, reproductive freedom. Women of colour lead the movement of no more forced sterilization, but this was not fully embraced by mainstream feminism

Answer 50

Second wave feminism

Question 51

More about intersectionality – equality and oppression relating to “racism, able-bodieism, ageism, speciesism, classism, thinism, sexism, anti-semitism and heterosexismracism, “ Riot Grrrl Manifesto 1991

Answer 51

Third wave 1991- ??

Question 52

feminism that is queer, sex-positive, trans-inclusive, body-positive, and digitally driven.

Answer 52

Fourth wave maybe now?

Question 53

Problems are viewed in a sociopolitical and cultural context The psychological oppression that women and minorities have experienced is acknowledged The client knows what is best for their life and is the expert Emphasis is on educating clients about the therapy process Traditional ways of assessing psychological health are challenged Clients are encouraged to take social action related to many forms of oppression

Answer 53

Feminist perspectives key concepts

Question 53

Political and critical consciousness are central concepts Committed to social change Voices and ways of knowing, and the voices of others who have been oppressed, are valued and honored The counseling relationship is equal Focuses on strengths and offers a reformulated definition of psychological distress All types of oppression are recognized

Answer 53

Principles of feminist theory

Question 54

The view that people experience oppression in varying configurations and in varying degrees of intensity. Cultural patterns of oppression are not only interrelated, but are bound together and influenced by the intersectional systems of society. Examples of this include race, gender, class, ability, and ethnicity.

Answer 54

Intersectionality

Question 55

Become aware of their own gender-role socialization Identify their internalized messages of oppression and replace them with more self-enhancing beliefs Develop a sense of personal and social power Recognize the power of relationships and connectedness Evaluate the impact of social factors on their lives

Answer 55

Goals of feminist theory

Question 56

Empowerment Self-Disclosure Gender-Role or Social Identity Analysis Gender-Role Intervention Power Analysis Bibliotherapy Assertiveness Training Reframing and Relabeling Social Action Group Work

Answer 56

Feminist techniques

Question 57

Most in common with the multicultural and social justice perspectives Clinicians strive to create an egalitarian relationship and collaborate with clients in setting goals and choosing strategies Has paved the way for gender and culturally sensitive practice Has made significant theoretical and professional advances in counseling practice Can incorporate principles and techniques into many therapy models

Answer 57

Feminist strengths

Question 58

Advocating for change in the social structure can be problematic when working with women who do not share these beliefs If therapists do not fully understand and respect the cultural values of clients from diverse groups, they run the risk of imposing their own values Therapists do not take a value neutral stance More empirical support is needed for this approach

Answer 58

Feminist limitations

Question 59

Technical Integration Theoretical Integration Assimilative Integration

Answer 59

Approaches to integration

Question 60

Emphasizes common elements across different theoretical systems: Empathy Support Therapeutic relationship Common factors are more important in accounting for therapeutic outcomes than the unique factors that differentiate one theory from another

Answer 60

Integration - common factors

Question 61

Current theories can and should be expanded to incorporate a multicultural dimension Practitioners need to tailor their theory and practice to fit the unique needs of the client Practitioners should be aware of their own and their clients’ worldviews, and use culturally appropriate interventions

Answer 61

Integration of multicultural perspectives

Question 62

Spiritual and religious matters are therapeutically relevant and ethically appropriate to discuss in counseling Spiritually informed therapy is a form of multicultural therapy Clients in crisis may find a source of comfort, support, and strength in drawing upon their spiritual resources

Answer 62

Integration of spiritual and religious perspectives

Question 63

Distinguishing between spirituality and religion Active listening Conversing about spiritual issues Seeing client as a person, not an illness Careful spiritual assessment Being present Being aware of own spirituality Engaging in various spiritual interventions Facilitating spiritual growth Referring to pastoral care

Answer 63

Psych nurses role - spirituality

Question 64

FIT is an evidence-based practice that monitors client change and identifies modifications needed to enhance therapy The Outcome Rating Scale (ORS) and Session Rating Scale (SRS) are used to measure client progress and to rate the quality of the therapeutic relationship

Answer 64

Feedback informed treatment

Question 65

designed to evaluate and to improve the quality and effectiveness of counseling services

Answer 65

Feedback informed treatment (FIT)

Question 66

refers to the range of activities that members of our profession are educated in and legally authorized to provide

Answer 66

Scope of practice

Question 67

In regards to individual counselling competencies include: - Apply therapeutic use of self to inform all areas of psychiatric nursing practice - Establish, maintain and terminate a therapeutic relationship with the client - Demonstrate knowledge of therapeutic modalities - Use reflective practice and evidence to guide psychiatric nursing practice - Integrate cultural awareness, safety and sensitivity into practice - Uphold and promote the ethical values of the profession

Answer 67

Entry level competencies

Question 68

Up until this August (2022), Registered Psychiatric Nurses are followed the Registered Psychiatric Nurses Act. Now, the profession has moved under the _____________________

Answer 68

Regulated Health Professionals Act