Deck 12: Challenging Clients and Demanding Situations

Question 1

_____________________ involves the therapist's efforts to accept and welcome all client comments, even hostile or provocative comments.

A) Radical validation
B) Emotional acceptance
C) Radical acceptance
D) Coming alongside
E) None of the above

Answer 1

A

Question 2

In the text it is emphasized that resistance is:

A) Natural
B) Unnatural
C) Always the clinician's fault
D) Obvious
E) Only A and D

Answer 2

A

Question 3

Which of the following is NOT an example of a goal-oriented question?

A) "What would make this a helpful visit?"
B) "If we have a great meeting today, what will happen?"
C) "What would need to happen for this to be productive?"
D) "What would you like to talk about today?"
E) All of the above are goal-oriented questions

Answer 3

D

Question 4

In the text it is emphasized that resistance can emanate from:

A) The client
B) The therapist
C) The situation
D) All of the above
E) Only A and B

Question 5

From the motivational interviewing approach of Miller and Rollnick (2013), a key concept in understanding why clients might be resistant to change is:

A) They are in the contemplation stage.
B) They are in the precontemplation stage.
C) They are ambivalent.
D) They are not yet customers for change.
E) None of the above

Question 6

One rule (or rhythm) about open questions when using motivational interviewing is:

A) Use three times as many questions as reflections
B) Ask an open question and then reflect what the person says, perhaps two reflections per question
C) Use one question and one reflection and one question and so on.
D) Ask no more than one question per minute
E) There are no rules about open questions in motivational interviewing

Question 7

Sometimes when working with resistant clients, therapists intentionally overstate the client's position in an effort to get clients to clarify or articulate the more positive side of an issue. Motivational interviewers refer to this technique as:

A) Motivational reflection.
B) Motivational paraphrase.
C) Amplified reflection.
D) Extreme reflection.
E) Confrontation

Question 8

Which therapy approach views resistance as an unhelpful linguistic creation that developed because sometimes clients don't want to do what their "bossy-pants" therapists want them to do?

A) Solution-focused therapists
B) Psychoanalytic therapists
C) Person-centered therapists
D) Cognitive-behavioral therapists
E) Jungian therapists

Question 9

Which technique is characterized by the statement, "Thank you for being honest with me and telling me what you really think"?

A) Emotional validation
B) Amplified reflection
C) Coming alongside
D) Radical acceptance
E) Confrontation

Question 10

Miller and Rollnick claim that which of the following can be "deadly for engagement?"

A) Using repeated open questions
B) Chaining together a series of closed questions
C) Chaining together a series of reflections
D) Mixing more reflections than questions into an interview
E) Both C and D

Question 11

"Natural resistance" refers to:

A) Client resistance to something that is natural and good in his or her life.
B) Therapist resistance to working with clients who do not want to be in therapy.
C) Client resistance that stems from being in an uncomfortable situation but that also acknowledges the fact that clients are behaving in ways that challenge the therapist.
D) Client resistance to paying for psychotherapy.
E) None of the above.

Question 12

Which of the following is an example of emotional validation or feeling validation?

A) "It pretty much sucks that the judge required you to come and see me."
B) "What brings you here?"
C) "How would you feel if we just ignore the judge's order and you don't have to come to therapy?"
D) "It's time for you to get serious about getting your life in order."
E) "Are you aware of how much harm you've caused your loved ones?"

Question 13

What term do Miller and Rollnick use to describe paradox?

A) Coming alongside
B) Amplified reflection
C) Undershooting
D) Concession
E) Radical acceptance

Question 14

Which of the following statements is NOT true of client resistance?

A) Freud believed that resistance was inevitable and occurred in virtually all clients.
B) The clients themselves are always solely responsible for resistance.
C) Some contemporary practitioners and writers believe that resistance does not exist.
D) Therapist behavior can sometimes produce resistance in clients.
E) All of the above are true

Question 15

Autumn says to her interviewer, "I should quit smoking because smoking is expensive and unhealthy." According to the motivational interviewing model, Autumn also might be having an ambivalent thought like:

A) I should keep smoking because it's pleasurable and gives me good feelings
B) Smoking is an unnatural act
C) Smoking will motivate me to get a better job
D) Being unhealthy will be expensive
E) Only A and D

Question 16

Amplified reflection involves:

A) Intentionally overstating the client's main message
B) Intentionally emphasizing or amplifying the healthy side of the client's ambivalence
C) Strengthening the healthy side of the client's ambivalence
D) Using microphones and recordings in an interview for playback and review
E) Both B and C

Question 17

At the beginning of his first appointment, Bobby says to his interviewer, "I'm not talking and you can't make me." Bobby's interviewer's response, "You're absolutely right-I sure can't make you talk," is an example of which of the following?

A) Amplified reflection
B) Reflection of feeling
C) Feeling validation
D) Concession
E) None of the above

Question 18

Undershooting involves:

A) Intentionally overstating the client's main message
B) Intentionally emphasizing or amplifying the healthy side of the client's ambivalence
C) Strengthening the healthy side of the client's ambivalence
D) Using microphones and recordings in an interview for playback and review
E) None of the above

Question 19

Which of the following is the central MI hypothesis for resolving client ambivalence and activating motivation?

A) Therapists stimulate motivation through lecturing clients
B) Therapists should stay completely nondirective and let clients discover their own motivation
C) The client should be voicing the arguments for change
D) Confrontation stimulates change
E) Therapists must voice the arguments for change

Question 20

Traditionally, signs of client resistance included:

A) Talking too much. B. Talking too little.
C) Being unprepared for psychotherapy.
D) All of the above.
E) Only A and B.

Question 21

In the large-scale Pittsburgh study, which of the following variables was associated with homicidal violence?

A) Carrying a weapon
B) A conduct disorder diagnosis
C) Selling hard drugs
D) All of the above
E) Only A and C

Question 22

Psychological first aid was developed as an alternative to:

A) Trauma focused cognitive behavioral therapy
B) Person-centered therapy
C) Critical incident stress debriefing
D) Solution-focused therapy
E) None of the above

Question 23

The research suggests that the prediction of violence is:

A) Simple and straightforward.
B) Best predicted when clients make specific threats.
C) Best predicted by actuarial approaches.
D) Best predicted via clinical judgment.
D) Completely unpredictable.

Question 24

Dae-Ho has a new client with a diagnosis of schizophrenia. Which of the following statements is true?

A) The client is much MORE likely to engage in violence than clients without a schizophrenia diagnosis
B) The client is much LESS likely to engage in violence than clients without a schizophrenia diagnosis
C) Whether the client is likely to commit violence depends on other factors, such as the intensity and frequency of the client's psychotic symptoms
D) Dae-Hos' client is more likely to engage in firesetting
E) None of the above.

Question 25

When using motivational interviewing with substance-using clients, it is recommended that therapists do all of the following EXCEPT:

A) Ask the client about a typical day or session.
B) Confront the client about his or her substance use.
C) Provide addiction information in a gentle, collaborative manner.
D) Ask the client about past and present substance use.
E) Interviewers should do all of the above.

Question 26

Which of the following is/are the most commonly used brief interview technique(s) for assessing for alcohol problems?

A) The CAGE questionnaire
B) The SASSI questionnaire
C) The NIAAA criteria
D) Both A and C
E) None of the above

Question 27

Which of the following is the clearest rationale for reporting potential violence to the authorities and warning potential victims?

A) When the client makes a specific threat.
B) When the client has a history of family violence.
C) When you hear about the potential for violence from an outside source.
D) When your clinical intuition dictates.
E) It is never ethical to break confidentiality for this reason

Question 28

Mika says, "Yes it's true that coming to counseling is a hassle and I hear you saying that you don't want to be here. But can I just be totally blunt and direct with you for a moment?" Which technique is Mika preparing to use?

A) Coming alongside
B) Amplified reflection
C) Undershooting
D) Genuine feedback
E) Radical acceptance

Question 29

All mental health service providers should enter disaster situations as part of:

A) An authorized helping organization
B) Cognitive-behavioral team
C) Critical incident stress debriefing team
D) Loosely organized group of helpers
E) A for-profit corporation

Question 30

Psychological first aid can be administered in:

A) Shelters
B) Schools
C) Hospitals
D) War zones
E) All of the above

Question 31

How is the TRADITIONAL substance abuse interviewing approach usually described?

A) As collaborative and empowering
B) As directive and confrontive
C) As motivational interviewing
D) As clever and suggestive
E) As manipulative and directive

Question 32

Which of the following statement is most accurate regarding the evidence-base of psychological first aid (PFA)?

A) It hasn't been sufficiently evaluated to determine its benefit
B) It has strong empirical support
C) Initial research indicates it may be contraindicated in the treatment of trauma
D) One well-controlled study showed it to be more effective than critical incident debriefing
E) None of the above

Question 33

Without specialized training, a therapist working with people who have experienced a disaster:

A) May experience vicarious trauma.
B) May actually do a better job because he/she won't be held back by rigid techniques.
C) May do more harm than good.
D) Only A and B
E) None of the above

Question 34

When working with clients who may be lying, it's important for therapists to use which of the following principles?

A) Ignore the possibility of deceit and proceed as usual.
B) Tell the client, "I believe you."
C) Let your client know that you're keeping an open mind about his or her truthfulness, but avoid becoming a judge who must determine whether the client is telling the truth.
D) Directly tell the client, "I don't believe what you're saying."
E) Any of the above would be appropriate

Question 35

When initiating contact with a person who has experienced a disaster a therapist should:

A) Tell the person that everything will be alright.
B) Explain his/her role in the situation
C) Ask permission to initiate the contact
D) Only B and C
E) All of the above

Question 36

Leonys has a client who has a history of firesetting. During the initial session, the client makes threatening remarks about getting revenge on the owner of a local business. If he becomes violent, which behavior is Leonys's client most likely to engage in?

A) He's most likely to use a firearm to seek revenge.
B) The biggest danger is that he'll set a fire.
C) There's really no danger as the client is likely blowing smoke.
D) Violence is violence; he's likely to seek revenge, but the method is unpredictable.
E) None of the above.

Question 37

Which of the following basic interviewing responses is most likely to facilitate cooperation and reduce resistance?

A) Confrontation
B) Clarification
C) Interpretation
D) Suggestion
E) Reflection

Question 38

Which of the following therapist responses would NOT be appropriate with a hostile client?

A) Genuine feedback
B) Lecturing
C) Emotional validation
D) Reframing
E) All of the above are appropriate

Question 39

Which of the following is/are the goal(s) of psychological first aid?

A) Reduce initial post-trauma distress
B) Support short- and long-term adaptive functioning
C) Give mental health diagnoses to all people that have experienced a disaster as soon as possible
D) Only A and B
E) All of the above

Question 40

Allen's client is hostile toward him from minute one in the interview. Allen's response is: "Thanks for being so honest about how you feel about being here. I appreciate you just telling me directly what you think of me and of counseling. Which technique is Allen using?

A) Coming alongside
B) Amplified reflection
C) Undershooting
D) Concession
E) Radical acceptance

Question 41

Which statement is NOT true regarding interviewing clients in crisis or disaster environments?

A) People in crisis or disaster situations often need more structure and direction than clients in a usual psychotherapy interview.
B) Therapists should exercise caution when applying diagnostic labels to people in disaster situations.
C) Therapists must not recount the stories of people in disaster situations unless they receive permission from the interviewee.
D) All of the above are true.
E) Only A and B are true.

Question 42

James is an interviewer with his cultural humility. Which attitudes would you expect that he holds?

A) He values the cultural practices of others
B) He actively teaches everyone about his moral and religious perspective
C) He has let go of any ideas about his own superiority
D) Both A and B are true
E) Both A and C are true

Question 43

Vicarious trauma can include:

A) Flashbacks or nightmares
B) Self-blame
C) Hypervigilence
D) Any or all of the above
E) Vicarious trauma is vicarious and doesn't include any symptoms

Question 44

Human responses to trauma and crisis vary across three domains. Which of the following is NOT one of those domains?

A) The nature of the crisis
B) Coping skills, ego strength, and resources available to individual survivors
C) Cultural beliefs and practices associated with trauma
D) Level of psychopathology
E) Human responses vary across the four preceding domains

Question 45

It is beneficial for trauma survivors to talk about their experiences within _____ hours after the traumatic event.

A) 1
B) 24
C) 48
D) 72
E) 144

Question 46

Which is the most true with regard to cultural knowledge and crisis/disaster work?

A) Cultural knowledge is not needed during crises
B) It's good to acquire general multicultural knowledge before you arrive on the scene
C) Unfortunately, there are no guides to cultural competency is disaster work
D) Both A and C are true
E) None of the above

Question 47

What standards are available for cultural competencies in disaster mental health?

A) There are many different competency standards for disaster personnel
B) There are only the DHHS competency standards
C) Unfortunately, there is no guide to cultural competency in disaster work
D) Both A and C are true
E) None of the above

Question 48

Which of the following is a reason a victim of trauma may be reluctant to talk to a mental health professional?

A) Thinking/talking about trauma brings up extremely uncomfortable feelings
B) Victims of trauma may have a hard time trusting in a stranger
C) Trauma survivors may feel ashamed or guilty about what they experienced
D) All of the above are reasons a trauma victim may be reluctant to speak with a mental health professional.
E) Victims of trauma are never reluctant to talk about their experience.