LSCW sample exam question

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You have been asked by a social work student about the origin of anxiety according to Sigmund Freud and his psychoanalytic theory. Your understanding of Freudian theory allows you to explain the BEST answer is ... A) emotional reactions to strangers during infancy. B) the need and ability to repress id impulses. C) the process of resolving conflicts between the id, the superego, and reality. D) the process of freeing yourself from symbiotic relationships.

Freud once said "life is not easy!" The ego -- the "I" -- sits at the center of some pretty powerful forces: reality; society, as represented by the superego; biology, as represented by the id. When these make conflicting demands upon the poor ego, it is understandable if it -- if you -- feel threatened, feel overwhelmed, feel as if it were about to collapse under the weight of it all. This feeling is called anxiety, and it serves as a signal to the ego that its survival, and with it the survival of the whole organism, is in jeopardy. Freud mentions three different kinds of anxieties: The first is realistic anxiety, which you and I would call fear. Actually Freud did, too, in German. But his translators thought "fear" too mundane! Nevertheless, if I throw you into a pit of poisonous snakes, you might experience realistic anxiety. The second is moral anxiety. This is what we feel when the threat comes not from the outer, physical world, but from the internalized social world of the superego. It is, in fact, just another word for feelings like shame and guilt and the fear of punishment. The last is neurotic anxiety. This is the fear of being overwhelmed by impulses from the id. If you have ever felt like you were about to "lose it," lose control, your temper, your rationality, or even your mind, you have felt neurotic anxiety. Neurotic is actually the Latin word for nervous, so this is nervous anxiety. It is this kind of anxiety that intrigued Freud most, and we usually just call it anxiety, plain and simple. http://webspace.ship.edu/cgboer/freud.html A is INCORRECT This may cause the organism anxiety, but it is not the psychoanalytic origin of anxiety. B is INCORRECT This may cause the organism anxiety, but it is not the psychoanalytic origin of anxiety. D is INCORRECT Psychologically, we use the term symbiosis in a similar way to describe a relationship where two people function as one. However, in contrast to the biological term, it refers to a relationship pattern which is not healthy, since a couple is existentially two separate people who need to be separate for both of them to be able to express their individuality and different needs. Symbiosis can best be explained with the use of the ego state model. Picture two people. Both of them have three ego states, a parent ego state, an adult ego state and a child ego state. A healthy relationship can be described as one where both people can use all their ego states to relate to the other person. This means there is flexibility in the relationship. One person might be looking after the other for a while using their parent ego state while the other receives the care from a child ego state place. Then they go on to talk about daily routines, both using their adult ego states. And in the end, when matters are clarified, they might go on to play with each other, both accessing their child ego states. In a relationship with a symbiotic pattern, both people use only some of their ego states to relate to each other, resulting in less flexibility. It's as if both partners take on stable roles and don't come out of them again. In symbiosis, two people function as if they only had one set of ego states between them. For example, person A might use their parent ego state and adult ego state to relate to person B, who mostly uses his or her child ego state to relate to A. Between them they only have one parent, one adult and one child ego state that is activated. This results in stable roles of A being the "carer" or the "responsible one", and B gets to be looked after. The same pattern will also result in a power differential between both partners. A gets to say what will happen, and B consents and follows. Or there might be a pattern , where B normally gets his or her way by using child-like tactics such as emotional blackmail or tantrums. Both partners lose out in this pattern. Person A often gets power and can feel needed (for some people that will be part of their script), but they will miss out on being looked after or looking after themselves properly, because they don't access their child ego state and don't go with what they need and want for themselves. Person A might also not get a lot of time to play, but might always feel responsible for what is going on. Person B will get looked after, but that can also be experienced as belittling and not allowing person B to own their own power and competency. Person B doesn't access his or her adult and parent ego states and stays in a place of passive dependency. The symbiotic pattern results in the classical set-up of a rescuer or caretaker and a needy and dependent partner in a relationship. It doesn't allow for flexibility or equality and it limits both partners in their freedom to be themselves. However, both partners may have an investment in keeping the symbiosis going. Symbiotic relationships can be extremely stable and feel like they are very close, because they don't allow for difference. The roles are very predictable and therefore might feel very safe. Both partners know what's expected of them. Also, the roles in the symbiosis are learned in childhood. Person A might have started to be an emotional carer for his or her parents, when he or she was still a small child. Staying with this role as an adult allows him or her to stay within their script. The same is true for person B. He or she might have learned that it's best to stay little and not take responsibility or want his or her own way and staying within this role in an adult relationship means they don't have to change and look at themselves.

You are working with a mother and father who have an 8-year-old male child. During the first family session you notice the child does not seem very expressive. Each time the child begins to express emotions the parents jump in and squash it. Twice while describing an incident at school the child becomes emotional and then parents tell him "get control of yourself" and "boys don't whine." With this type of parenting you would expect to see which of the following symptoms currently? A) high anxiety levels. B) eating disorders. C) psychomotor problems. D) acting-out behavior and somatization

The correct answer is A From age 6 to 12 a child is learning "methods of interacting" and "competence at interacting with others." This requires they learn to cope with their emotions. During this stage of development the goal is to create and develop new skills and knowledge. If we are allowed to do this, we develop a sense of "industry" or competence. Part of this stage is the development of control over our emotions, especially when dealing with other people. If the child fails to learn how to resolve feelings, they can develop a sense of inadequacy and inferiority. This will almost certainly damage self-esteem and competence. The parents are interfering with his ability to learn how to handle his emotions. Without an external outlet, he is likely to compensate for this lack of training in the form of internalized anxiety and fear. B is INCORRECT Eating disorders follow a similar path but there is no indication that there is a problem with food. It is possible, if this were a female instead of a male, they might begin to exercise control over themselves and their family, by controlling their food intact and /or binging and purging. C is INCORRECT Psychomotor problems are not usually associated with a compensation mechanism at this age. If you see psychomotor issues, it would be best to get a medical evaluation, preferably from a neurologist, immediately. D is INCORRECT Given the data in the question, this would not seem to be a problem, however, if this were to continue unabated, you might certainly begin to see this type of behavior by age 12 or 13. This boy will eventually learn to compensate for having their emotions squashed, but it will probably be a "non-productive" form of compensation.

You are reading an admission note written by an intern. Given the brief information, what would your FIRST preliminary diagnosis be? Patient alert and oriented x 3, pleasant with good eye contact. Patient seems coherent but appears to be internally distracted at certain times. Mood is appropriate and he says he is feeling "better". Affect is broad and covers the full range. Patient denies suicidal ideation, denies homicidal, and denies a passive death wish. Patient endorses auditory hallucinations but denies visual hallucinations. Patient's insight appears impaired due to his Polysubstance abuse. Judgment appears poor with very little impulse control and he occasionally appears to refer to internal stimuli. Patient's fund of knowledge appears depleted. A) Psychosis B) Schizophrenia C) Bipolar Disorder D) Anxiety Disorder

The correct answer is A It is valuable to understand the difference between psychosis and schizophrenia. Psychosis is a general term used to describe psychotic symptoms. Schizophrenia is a kind of psychosis. Several different brain disorders can lead to psychotic symptoms, including lesions in the brain resulting from head traumas, strokes, tumors, infections or the use of illegal drugs. If a serious depression goes untreated for a long time, psychotic symptoms may develop. These examples demonstrate that not all psychosis is schizophrenia. If is for this reason that doctors may take quite some time (6 months or more) to diagnose someone, because while the symptoms of schizophrenia are quite obvious - the fact that the symptoms are not being caused by some other brain disorder is frequently not obvious. http://schizophrenia.com/diag.html#psychosis B IS INCORRECT In order to correctly diagnosis schizophrenia, you need at least 6 months worth of symptoms. There is no indication of any time frame in the question. C IS INCORRECT Bipolar disorder diagnosis requires the gathering of a tremendous amount of information prior to diagnosis. There is not enough information given, nor is the length of time the symptoms are present given, that would allow you to consider this diagnosis. D IS INCORRECT Nothing in the information says Anxiety Disorder

** A cognitive bias is a pattern of "deviation in judgment" often brought out by a particular situation. It is very easy to allow a cognitive bias to affect your perception. In the following, you have just received a case and are reading the client's previous file. You realize they have had three admissions during the past two years. In two of the admissions they were diagnosed with Bipolar Disorder NOS and in the third, a Major Depressive Disorder. You decide that they are coming into see you for issues relating to their bipolar diagnosis in order to keep them from needing a re-hospitalization. It is very possible, with that decision, that you have just committed a cognitive bias, which will interfere with what you can do to assist them. The BEST description of the cognitive bias you may have used is... Anchoring bias Attentional Bias Bandwagon Bias Bias blind spot

The correct answer is A The Anchoring Bias is the common human tendency to rely too heavily, or "anchor," on one piece of information or one trait when making decisions. The client is more than their diagnosis and both sets of diagnoses may be wrong, skewed of inappropriate. B is INCORRECT The Attentional Bias is the implicit cognitive bias defined as the tendency of emotionally dominant stimuli in one's environment to preferentially draw and hold attention. C is INCORRECT The Bandwagon Bias is the tendency to do (or believe) things because many other people do (or believe) the same. Related to groupthink and herd behavior. D is INCORRECT The Blind Spot Bias is the tendency to see oneself as less biased than other people. Personal Note: It is my belief that given the expanded caseloads and lack of staff we, as social workers, have had to cope with over the past decade, it is very easy to become "sloppy" in our diagnosis. This can be related to lack of time to correctly diagnose or just plain exhaustion. You should always come to your own diagnosis.

You have just completed your 4th session with Matthew, a 35-year-old male who has served two brief prison terms. The first incarceration was for two years and the second for three. He has been out of prison for 7 years. He identifies himself as a devout churchgoer who never misses a service and enjoys being part of his church community. During your sessions, he peppers his language with bible quotes and admonitions. He came to therapy for complaints about stress and anxiety in his life. At this beginning of this session, he admitted that his stress was caused by a letter he received from the State Police Agency declaring him a "person of interest" in a current investigation involving insurance fraud. He stated that while he is an insurance agent he is also very religious. He does not understand why he is being "targeted" in this investigation. Upon questioning, he admits his prior two incarcerations involve fraud and larceny. He also shows no remorse for his prior actions and seems more upset about being arrested and losing his job than disappointing his church friends. You realize you may be dealing with a client who has a past diagnosis of anti-social personality disorder and he is deeply involved in the thinking error known as ... A) fragmented personality B) justifying C) fronting D) grandiosity

The correct answer is A The fragmented personality thinking error is common in persons with antisocial features. It is a method where they can interpersonal conflict by separating themselves into two personality sets. They have a core belief that they are a good person and therefore could do no wrong. If they do something exploitive or hurtful they can justify it by making the logical leap: "If I am a good person and I hurt someone, they must have done something to deserve it, because I would not hurt them for any reason. They caused it. It has nothing to do with whether or not I am a good person." This thinking error allows them to refuse to look at the inconsistency between their beliefs and actions. B is INCORRECT Justifying is also an externalizing thinking error. It allows the user to place all blame outside of them and therefore be able to avoid responsibility. Statements you may hear which could clue you in on this error would include: "He yelled at me so I had a right to hit him." "She was mean to me so I broke her pottery." C is INCORRECT Fronting occurs when the client creates a persona, which they use to try to convince you they are something or someone they are not. This error is similar to a conscious splitting where they can deny behaviors they have committed by refusing or denying they committed the behaviors. This error responds well to a simple statement that you know they are fronting and they should stop. D is INCORRECT A person using the thinking error "Grandiosity" often has an exaggerated sense of self-importance or ability. They often feel they are the best or the best at doing something. They refuse to process any of their actions, which could conflict with this thinking pattern. This client is minimizing or maximizing the significance of an issue, and it justifies not solving the problem. Statements you may hear from a client involved in this thinking error may include: "I hate school; I could run the classroom better than that stupid teacher." Or "Coach is stupid; I am a better player than him. I should be playing Quarterback!"

You are working with a client in a hospital setting. They indicate that want to run down to the cafeteria and get themselves a cup of coffee and asks you if they can get you a cup of coffee as well. The BEST thing to do is to... A) Decline the coffee but thank the client for their thoughtfulness. B) Accept the offer because it is "just a cup of coffee" and it is a token gesture of respect. C) Decline the offer but offer to walk down to the cafeteria with the client and get your own cup of coffee. D) Accept their invitation but offer to pay for your coffee

The correct answer is A This is a clear example of what ethics professionals call the "slippery slope". The chances of you accepting a cup of coffee as a token gesture will probably have no impact on your relationship with the client. But, you have just crossed a boundary, no matter how small, and the relationship has changed in ways that you cannot predict. You do not know what "buying a cup of coffee means to the client"! In some cultures, providing food and drink is very important and sets up very clear roles. What happens the next time the client meets you and wants a cup of coffee but only has enough money for themselves. They then decide to forgo the coffee rather than embarrass themselves by not being able to but you one. Alternatively, they say, "Hey, I want a cup of coffee and I am broke today, since I got last time, how about you getting them this time?" Simple things can get complicated very fast when you do not maintain clear boundaries. Remember, boundaries are nothing more than rules you create about how to interact with other people. Make your rules and do not violate them and you will be much happier as a therapist. B is INCORRECT Nothing is "Just a ..." All human behavior is rooted in needs. The client knows some of these needs and some are unknown and unconscious. Sharing food and drink is a rather intimate gesture. It is often a gesture among equals or among persons trying to start a relationship based on equality. The relationship between you and your client is never equal and never will be. C is INCORRECT This is an acceptable answer but not the BEST answer. By walking down to the cafeteria with them, they may perceive the relationship as more than therapist-client. If it is not a behavior you would do in your office with a client, then do not do it outside of your office. D is INCORRECT The moment you accept this offer, you have begun to change the boundaries of the relationship in very subtle ways. Whether you ultimately pay or not.

Albert Bandura proposed Social Learning Theory. One of its main tenets is BEST described as... A) the acquisition of a new behavior requires cognitive insight. B) behavior is learned through a process called modeling. C) reinforcement is not required to learn new behaviors D) new behaviors are acquired through stimulus-response connections

The correct answer is B Albert Bandura believed that aggression is learned through a process called behavior modeling. He believed that individuals do not actually inherit violent tendencies, but they modeled them after three principles (Bandura, 1976: p.204). Albert Bandura argued that individuals, especially children learn aggressive responses from observing others, either personally or through the media and environment. He stated that many individuals believed that aggression will produce reinforcements. These reinforcements can formulate into reduction of tension, gaining financial rewards, or gaining the praise of others, or building self-esteem (Siegel, 1992: p.171). In the Bobo doll experiment, the children imitated the aggression of the adults because of the rewarded gained. Albert Bandura was interested in child development. If aggression was diagnosed early in children, Bandura believe that children would reframe from being adult criminals. "Albert Bandura argued that aggression in children is influenced by the reinforcement of family members, the media, and the environment"(Bandura, 1976: pp. 206-208). http://www.criminology.fsu.edu/crimtheory/bandura.htm A IS INCORRECT Bandura was not convinced that insight had a major role in the acquisition of behaviors. C is INCORRECT Reinforcement is not required to learn a new behavior, but it may well be key in determining if the behavior is maintained or extinguished. D is INCORRECT Bandura felt S-R connections may increase or decrease behavior, but were not essential in learning a new behavior.

You are reviewing a chart of a patient who is being referred to you from a colleague. You notice in the chart a previous clinician has written, "Client has periods of time where they report depersonalization." You understand the BEST way to understand the client is to understand that 'Depersonalization' is characterized by A) severe free-floating anxiety. B) disorientation combined with a loss of ego functions. C) extreme avoidance and irrational fear. D) internalized voices which tell the person they are 'bad'.

The correct answer is B Depersonalization as an isolated event occurs in many people without significantly affecting their functioning; it is considered a disorder only when it impairs the patient's daily activities, when it is not associated with some other mental disorder, and when the patient's perception of reality remains intact. Similar definitions would include... 1) alteration in the perception of self so that the usual sense of one's own reality is temporarily lost or changed; it may be a manifestation of a neurosis or another mental disorder or can occur in mild form in normal persons. 2) a state in which the normal sense of personal identity and reality is lost, characterized by feelings that one's actions and speech cannot be controlled. 3) a dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving. 4) a feeling of strangeness or unreality concerning oneself or the environment, often resulting from anxiety, stress, or fatigue. 5) alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self-estrangement, in changes of body image, or in a feeling that one does not control one's own actions and speech; seen in disorders such as depersonalization disorder (see also dissociative disorders), depression, hypochondriasis, temporal lobe epilepsy, schizophrenia, and schizotypal personality disorder. A IS INCORRECT This is more of what would be seen with a Generalized Anxiety Disorder. C is INCORRECT This is seen more with paranoia. D is INCORRECT This defines auditory hallucinations.

You are working with a younger social worker who asks you about the behavioral model. They are specifically interested in the difference between reinforcement and punishment. You understand the BEST way to answer this question is... A) the stimuli and response mechanism. B) the increase in a behavior versus the decrease in a behavior. C) removing a pleasant or an unpleasant stimuli. D) presenting a pleasant or an unpleasant stimuli.

The correct answer is B Generally, reinforcement of a behavior will result in a increase in the behavior while punishing a behavior will result in a decrease in the behavior. This is basic and vital to the theory of behavioral psychology. A is INCORRECT This is an aspect of the behavioral model, but it does not directly deal with reinforcement. It is the underlying principle which allows reinforcement or punishment to alter behavioral frequency. C is INCORRECT These are both aspects of punishment and reinforcement. D is INCORRECT These are both aspects of punishment and reinforcement

You have begun working with a 67 year-old male who has recently retired from a job at a manufacturing plant where he had worked for the last 26 years. His initial complaints are depression, isolation and a general feeling of uselessness. You ask about his interactions with friends and he says he has no-one but his wife of 35 years. He jokes that she is getting tired of him hanging around the house. Your BEST intervention would be to... A) Work with him to schedule a second honeymoon with his wife B) explore different possible activities which could help bring usefulness back into his life. C) locate some vocational training so he can go back to work and feel productive again. D) help him locate a support group in order to further his adjustment in retirement.

The correct answer is B This client is undergoing a very understandable grief process as the loss of his way of life. Our working situation structures our life. He has probably driven the same route, 5 days a week, for the past 27 years. Eaten at the same restaurants and talked with the same people. Now he has none of that. He feels anchorless and floating-free. You need to help him explore activities and ideas which can allow him to become part of something bigger than himself. Most people want to be part of something which means more than they do as an individual. A IS INCORRECT Maybe something nice to do after he has adjusted, but there is no reason to indicate it would help his current issues. C IS INCORRECT He does not need vocational skills, he needs to learn how to adjust to retirement. D IS INCORRECT Maybe after you do some exploration, but certainly not before. This would be akin to abandoning him.

You are working in a clinic and during a staff meeting a social worker discusses his client's behavior in terms of the "games" they are playing and the "scripts" they are enacting. You know this social worker has been trained in... A) Reality therapy. B) Transactional Analysis. C) Rational-Emotive therapy. D) Gestalt therapy.

The correct answer is B Transactional analysis, commonly known as TA to its adherents, is an integrative approach to the theory of psychology and psychotherapy. It is described as integrative because it has elements of psychoanalytic, humanist and cognitive approaches. TA was first developed by Canadian-born US psychiatrist, Eric Berne, starting in the late 1950s. According to the International Transactional Analysis Association, TA is a theory of personality and a systematic psychotherapy for personal growth and personal change'. 1. As a theory of personality, TA describes how people are structured psychologically. It uses what is perhaps its best known model, the ego-state (Parent-Adult-Child) model, to do this. The same model helps explain how people function and express their personality in their behavior 2. It is a theory of communication that can be extended to the analysis of systems and organizations. 3. It offers a theory for child development by explaining how our adult patterns of life originated in childhood. This explanation is based on the idea of a "Life (or Childhood) Script": the assumption that we continue to re-play childhood strategies, even when this results in pain or defeat. Thus it claims to offer a theory of psychopathology. 4. In practical application, it can be used in the diagnosis and treatment of many types of psychological disorders and provides a method of therapy for individuals, couples, families and groups. 5. Outside the therapeutic field, it has been used in education to help teachers remain in clear communication at an appropriate level, in counseling and consultancy, in management and communications training and by other bodies. Transactions and Strokes · Transactions are the flow of communication, and more specifically the unspoken psychological flow of communication that runs in parallel. Transactions occur simultaneously at both explicit and psychological levels. Example: sweet caring voice with sarcastic intent. To read the real communication requires both surface and non-verbal reading. · Strokes are the recognition, attention or responsiveness that one person gives another. Strokes can be positive (nicknamed "warm fuzzies") or negative ("cold pricklies"). A key idea is that people hunger for recognition, and that lacking positive strokes, will seek whatever kind they can, even if it is recognition of a negative kind. We test out as children what strategies and behaviors seem to get us strokes, of whatever kind we can get. People often create pressure in (or experience pressure from) others to communicate in a way that matches their style, so that a boss who talks to his staff as a controlling parent will often engender self-abasement or other childlike responses. Those employees who resist may get removed or labeled as "trouble". Transactions can be experienced as positive or negative depending on the nature of the strokes within them. However, a negative transaction is preferred to no transaction at all, because of a fundamental hunger for strokes. The nature of transactions is important to understanding communication. Life (or Childhood) script · Script is a life plan, directed to a reward. · Script is decisional and responsive; i.e., decided upon in childhood in response to perceptions of the world and as a means of living with and making sense of the world. It is not just thrust upon a person by external forces. · Script is reinforced by parents (or other influential figures and experiences). · Script is for the most part outside awareness. · Script is how we navigate and what we look for, the rest of reality is redefined (distorted) to match our filters. Each culture, country and people in the world has a Mythos, that is, a legend explaining its origins, core beliefs and purpose. According to TA, so do individual people. A person begins writing his/her own life story (script) at a young age, as he/she tries to make sense of the world and his place within it. Although it is revised throughout life, the core story is selected and decided upon typically by age 7. As adults it passes out of awareness. A life script might be "to be hurt many times, and suffer and make others feel bad when I die", and could result in a person indeed setting himself up for this, by adopting behaviors in childhood that produce exactly this effect. Though Berne identified several dozen common scripts, there are a practically infinite number of them. Though often largely destructive, scripts could as easily be mostly positive or beneficial. http://en.wikipedia.org/wiki/Transactional_analysis A IS INCORRECT Reality therapy (RT) is an approach to psychotherapy and counseling. Developed by William Glasser in the 1960s, it is considered a form of cognitive behavioral therapy. RT differs from conventional psychiatry, psychoanalysis and medical model schools of psychotherapy in that it focuses on what Glasser calls psychiatry's three R's: realism, responsibility, and right-and-wrong, rather than symptoms of mental disorders. Reality therapy maintains that the individual is suffering from a socially universal human condition rather than a mental illness. It is in the unsuccessful attainment of basic needs that a person's behavior moves away from the norm. Since fulfilling essential needs is part of a person's present life, reality therapy does not concern itself with a client's past. Neither does this type of therapy deal with unconscious mental processes. In these ways reality therapy is very different from other forms of psychotherapy. The reality therapy approach to counseling and problem-solving focuses on the here-and-now actions of the client and the ability to create and choose a better future. Typically, clients seek to discover what they really want and how they are currently choosing to behave in order to achieve these goals. According to Glasser, the social component of psychological disorders has been highly overlooked in the rush to label the population as sick or mentally ill. Reality therapy attempts to separate the client from the behavior. Just because someone is experiencing distress resulting from a social problem does not make him sick; it just makes him out of sync with his psychological needs. http://en.wikipedia.org/wiki/Reality_therapy C is INCORRECT Rational emotive behavior therapy (REBT), previously called rational therapy and rational emotive therapy, is a comprehensive, active-directive, philosophically and empirically based psychotherapy which focuses on resolving emotional and behavioral problems and disturbances and enabling people to lead happier and more fulfilling lives. REBT was created and developed by the American psychotherapist and psychologist Albert Ellis who was inspired by many of the teachings of Asian, Greek, Roman and modern philosophers. REBT is one form of cognitive behavior therapy (CBT) and was first expounded by Ellis in the mid-1950s; development continued until his death in 2007. http://en.wikipedia.org/wiki/Rational_emotive_therapy D is INCORRECT Gestalt therapy is an existential/experiential form of psychotherapy that emphasizes personal responsibility, and that focuses upon the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts of a person's life, and the self-regulating adjustments people make as a result of their overall situation. Gestalt therapy was developed by Fritz Perls, Laura Perls and Paul Goodman in the 1940s and 1950s. Gestalt therapy focuses on process (what is actually happening) as well as on content (what is being talked about). The emphasis is on what is being done, thought, and felt at the present moment (the phenomenality of both client and therapist), rather than on what was, might be, could be, or should have been. Gestalt therapy is a method of awareness practice (also called "mindfulness" in other clinical domains), by which perceiving, feeling, and acting are understood to be conducive to interpreting, explaining, and conceptualizing (the hermeneutics of experience). This distinction between direct experience versus indirect or secondary interpretation is developed in the process of therapy. The client learns to become aware of what he or she is doing and that triggers the ability to risk a shift or change. http://en.wikipedia.org/wiki/Gestalt_therapy

You have been supervising several MSW interns at a local crisis center and have determined they need more supervision and training in order to improve their treatment effectiveness. Your FIRST action which will provide the interns with the most benefit would be to... A) Begin group discussions about client welfare and ethical issues the interns may encounter B) Begin instruction in specific evidenced-based practices C) Re-orient the interns to the agencies mission statement. D) Discuss in groups the things that interfere with patient-therapist bonding.

The correct answer is B Evidence based practice is the best way to improve treatment effectiveness. Remember, the question only asks about how to make treatment more effective. Non-Evidenced-based practices may not allow you to focus on the root issue soon enough. It is important to understand that not all therapy that works is evidenced based. Sometimes, very powerful, effective and useful treatment can never be evidenced based because of it nature and the inability to place the various aspects into a testing design. Psychodynamic, Gestalt, Jungian, and Person-Centered therapy all meet these criteria. A IS INCORRECT Welfare and ethical issues are important, but do not specifically speak to treatment effectiveness. C IS INCORRECT The agencies mission statement is important, but not currently the greatest priority in turning around this agency. D IS INCORRECT An equally important issue, but not the one addressed by this question.

You have been engaged in a supervision session with a less experienced social worker. He asks the following question. Of the four following childhood behaviors, which is more common among boys than girls, you know the BEST answer is... Acting out sexually Aggression Running away Wetting the bed (Enuresis)

The correct answer is B Statistics are hard to come by and this appears to have roots both in the physical and the cultural. In general, adolescent males are more likely to act-out with aggression. This is probably related to the surge in testosterone (a male hormone) which comes around the early teen years. A is INCORRECT In general, girls are more prone to sexually acting out than boys. There appears to be multiple cultural and physiological issues involved in this answer, many of which are still being researched. Consider this a general interpretation of the data available. C is INCORRECT The data on this is very confusing. Some studies show girls more than guys and other studies show more equality between them (girl and guys run away at the same rate.) D is INCORRECT Once again the data is to muddles on this to be definitive. It would not be possible to say either sex has a higher prevalence rate.

The correct answer is B This client is undergoing a very understandable grief process as the loss of his way of life. Our working situation structures our life. He has probably driven the same route, 5 days a week, for the past 27 years. Eaten at the same restaurants and talked with the same people. Now he has none of that. He feels anchorless and floating-free. You need to help him explore activities and ideas, which can allow him to become part of something bigger than himself. Most people want to be part of something, which means more than they do as an individual. A IS INCORRECT Maybe something nice to do after he has adjusted, but there is no reason to indicate it would help his current issues. C IS INCORRECT He does not need vocational skills; he needs to learn how to adjust to retirement. D IS INCORRECT Maybe after you do some exploration, but certainly not before. This would be akin to abandoning him.

You are hospital social worker in charge of discharge planning for people in need of inpatient and outpatient rehab. Many of your clients have had traumatic brain injury due to motor vehicle accidents. You have a very firm working knowledge of the different services that Medicaid and Medicare will pay for. You also have good working relationships with most of the rehab centers within a 250-mile radius of your hospital. As part of your job responsibility, you often have to interface with the State Department of Health coordinator for brain and spinal cord injury. You have completed your licensure requirements, and are three weeks from being able to file an application to become an LCSW. The state coordinator is an MSW, approximately your age, but never and is not licensure. You are meeting with the mother of a 35-year-old female patient who was severely injured in a motor vehicle accident. You have been trying to find rehab for the client for the past 30 days. The client has been discharged from the hospital 22 days prior however, mother refuses to bring her home and no rehab has been willing to except her until today. During your consultation with the mother, the spinal cord injury project coordinator is involved. Multiple times during the conference, the MSW interrupts you and gives the mother inaccurate information regarding the benefits available to her daughter, telling the mother that she should demand the hospital pay for certain things, and provide her with certain services before she agrees to take her daughter home. Your BEST ethical obligation ... A) you should ignore the MSW and continue to provide accurate information to mother. B) you should interrupt the MSW and point out the incorrect information and then continue to try to provide correct information to mother. C) you should gracefully terminate the conference and reschedule with mother at a time when the social worker is not present. D) Because you are almost an LCSW you should call down the social worker, point out her errors, and ask her to excuse yourself from the conference.

The correct answer is B This is a very complex situation. Your primary ethical responsibility is to the client. It is to ensure they receive the correct and appropriate information they require to make appropriate decisions for their adult child. You need to supply her with the correct information as well as interfering with the other MSW providing her with incorrect information. Needless to say, this should be done with tact. Something like, "I am not sure that is correct. I have called ... And was given different information." As long as you can quote the source of your information, and the time frame in which your information was gathered, you should be alright. If you keep the exchange professional, and do not let your irritation takeover, the mother will figure out who has the most correct information. A is INCORRECT if you simply ignore the incorrect information being given by the other professional, to the mother, you run the risk of allowing mother to leave the meeting with incorrect information which may well cause problems for your client, the traumatic brain injury adult female. You have to accept responsibility for ensuring in that mother gets the correct information. As a social worker, there are many times when you will have to be confrontational. The trick is to be confrontational in a tactful manner, this is professional, and ensures that all parties grow and learn from the experience. C is INCORRECT While at first glance, this may seem like the best answer, it is not. This answer allows you to avoid a confrontation with the other professional. Many times in your work you will have to be confrontational. You are, after all, at your core, an advocate for your clients. The danger in answering this way is that you run the risk of allowing the mother to leave the conference with inaccurate information. And if the mother does not reschedule, or reschedules and does not show up she may well have left the conference with inaccurate information. Your job is to make sure that she has the accurate information she needs. D is INCORRECT In any exchange, as a social worker you must maintain a professional demeanor. During the conference with the mother, your personal feelings are irrelevant. You have a mandate, as a social worker, to provide the client was accurate and appropriate information. There is no room for personal feelings, at this point in time. This is not to say that your feelings are unimportant. Or that you should not feel hurt, angry, slighted or anyone of a number of other feelings. It simply means that as a professional social worker you need to separate your personal feelings from your professional work. There will be plenty of time, at a later date, to deal with the situation and your feelings.

You have taken a job as a prison social worker and one of your first clients of the day is a man serving a life sentence without the possibility of parole. He has served 8 years up to the point where you meet him. When you ask him why he requested an appointment with mental health he begins a long tirade about how everyone is against him. He tells you the dorm sergeant hates him and his fellow dorm members are always causing him problems. You have read his "prison jacket" and realize he has been sentenced for 1st Degree Murder. When you ask about the crime he was sentenced on he tells you it was not his fault. Upon further questioning, he decides to tell you his story. He went out one night to rob a local drug dealer because he needed cash. He took his brother's pistol. As he was robbing the dealer, the dealer pulled out a gun and shot him, wounded, but not incapacitated he fired back and killed the drug dealer. He was convinced that since the drug dealer shot him first, he was only acting in self-defense. He then stated that his lawyer "screwed him" because his lawyer refused to use self-defense as a legal defense for his actions. You realize the primary issue facing this inmate/client is his internalization of a specific criminal thinking pattern. You recognize this criminal thinking pattern to be... A) The "good person" stance B) the "victim" stance C) the "lack of time" stance D) the "unique person" stance

The correct answer is B Using the victim stance allows you to blame other people for what has happened to you. Your primary behavioral mechanism is to "point fingers at others" and "generate excuses" for your lack of success. The pay-off for this type of behavior is the ability to NOT ACCEPT responsibility for your life. There is no need to put in the hard work of actually determining why you are "where you are". Other examples of statements that show this thinking error are: The thief who says, "He (the victim) is the real criminal here. His watch only cost $75 and the court is making me pay restitution of $250. I do what I do because my father was a drunk. If he had cared about me and stopped drinking, I would not be like I am. My boss pays me minimum wage. I broke into his car because I needed some extra money. If people are going to pay such low wages, they got to expect I will have to steal to survive." A is INCORRECT The "Good person" stance is a thinking error that belongs to a class of BLACK and WHITE views of the world. You often see this type of behavior in people who have been diagnosed with a personality disorder. You are the good guy, no matter what you do. You see all behavior in terms of you being in the "right" and other people being in the "wrong". There is no GREY in your universal view. You actively ignore anything, which does not fit, nicely into your worldview. C is INCORRECT The "Lack-of-time" stance is a thinking error which focused only on the HERE and NOW. The person who used this stance will refuse to look at the past and will not be willing to explain past behaviors. They only are interested in their current needs and wants. These people often expect to be a big success without any effort. Common statements you may hear during a session are "You only live once" and "if I don't get it now, I may never get it." D is INCORRECT This thinking error has a lot in common with the ego defense mechanism of ENTITLEMENT. You believe that there is no one in the world like you, or that your experiences are unique among people and therefore you have a right to do what you want because the rules don't apply to you. This also plays into the feelings of superiority of your feelings because "you believe you will never get caught."

You have just begun working at an agency with a lengthy history. It has been in the community for many years. You attend your second weekly meeting and are very surprised at the interactions. It appears to you that the entire agency is caught up in a very solid "groupthink" atmosphere. You realize you need to begin to minimize the harmful effects of this groupthink. The BEST way to accomplish this task and increase the group's ability to make better decisions is to ... A) assist the group with exercises to increase group cohesion and interdependence. B) ask the group leader to present a his favorite solution at the start of meetings. C) encourage constructive dissidence and structured criticism. D) ask the group to make more risky decisions

The correct answer is C Groupthink is a tendency by groups to engage in a concurrence seeking manner. Groupthink refers to a deterioration of mental efficiency, reality testing, and moral judgment that results from in-group pressures. Groupthink occurs when group members give priority to sustaining concordance and internal harmony above critical examination of the issues under consideration. According to Irving Janis, the pioneer of Groupthink, it is a quick and easy way to refer to a mode of thinking that people engage in when they are deeply involved in a cohesive in-group, when the members' striving for unanimity override their motivation to realistically appraise alternative course of action. According to Turner, Pratkanis, et al in their 1997 work, Mitigating groupthink by stimulating constructive conflict, published by Sage Publications, the best way to mitigate groupthink is to stimulate discussion and promote constructive conflict in situations where groups might be likely to experience groupthink. To do this, we first briefly evaluate prior research on groupthink and describe our own model of groupthink, the social identity maintenance perspective. Once we understand the social dynamics and forces operating in the groupthink situation, we then offer methods of combating in adverse consequences by effectively stimulating cognitive conflict and reducing pressures towards identity maintenance that impede deliberative discussion. A is INCORRECT This approach would be likely to increase the effects of Groupthink. B is INCORRECT This approach would also be likely to increase the effects of groupthink. D is INCORRECT This effect may assist, but is not the 'roadmap' needed to fight groupthink.

You are discussing behavioral therapy and family systems theory with another social worker. They indicate they see a number of systems at play in the family which causes information to be used by the family to change or stay the same. They are interested in an appropriate nomenclature for this system. They ask you what they would call the process which acts to correct a family system in trouble and help restore it to a previous state of equilibrium. You know the BEST answer is... A) a feedback loop. B) positive feedback. C) negative feedback. D) neutral feedback loop

The correct answer is C If a system has overall a high degree of negative feedback, then the system will tend to be stable. A negative feedback loop has been likened to a homeostatic system, in which the feedback loop provides information that returns the system to some preset level and reduce deviation causes to the system. A IS INCORRECT Feedback is a process in which information about the past or the present influences the same phenomenon in the present or future. As part of a chain of cause-and-effect that forms a circuit or loop, the event is said to "feed back" into itself. Feedback is also a synonym for: Feedback signal - the measurement of the actual level of the parameter of interest. Feedback mechanism - the action or means used to subsequently modify the gap. Feedback loop - the complete causal path that leads from the initial detection of the gap to the subsequent modification of the gap. Ramaprasad (1983) defines feedback generally as "information about the gap between the actual level and the reference level of a system parameter which is used to alter the gap in some way", emphasizing that the information by itself is not feedback unless translated into action. Arkalgud Ramaprasad, "On The Definition of Feedback", Behavioral Science, Volume 28, Issue 1. 1983. B is INCORRECT Positive feedback tends to cause system instability. Winner (1996) described gifted children as driven by positive feedback loops involving setting their own learning course, this feeding back satisfaction, thus further setting their learning goals to higher levels and so on. Winner termed this positive feedback loop as a "rage to master." Winner, E. (1996). Gifted children: Myths and Realities. New York: Basic Books D is INCORRECT This does not exist.

You have been asked to help explain behavior modification principles to a new social worker. You know the primary application of behavior modification principles involves two major branches. One is called respondent conditioning and the other is called operant conditioning. Both are used by the behavior therapist in working with clients. In order to understand respondent condition better you provide the worker with the best explanation you can. Of the following, the BEST explanation is... A) operant conditioning replaces undesirable behaviors with more desirable ones through positive or negative reinforcement. B) operant condition pairs a neutral stimulus with a active stimulus. C) operant condition requires monitoring for a behavior close to the behavior you want to achieve and then reinforcing that behavior. D) operant conditioning comes from the work of John Watson, the Harvard Behaviorist

The correct answer is C Operant condition involves the presentation of a reward or reinforce when you want to strengthen a behavior or increase the frequency of a behavior, or the withdraw of a reward or the presentation of a punishment is you want to decrease the frequency of a behavior. When a child does something good and you say, "That is great...you are so smart...etc", you are engaging in operant conditioning by providing a positive stimulus to hopefully increase the behavior in the future. When a child goes towards an open door and you state "No!" you have presented a negative reinforcer and the likely hood of the child going for the door again is decreased. This is the basis of operant conditioning. Behavior modification is based on the principles of operant conditioning, which were developed by American behaviorist B. F. Skinner (1904-1990). Skinner formulated the concept of operant conditioning, through which behavior could be shaped by reinforcement or lack of it. Skinner considered his concept applicable to a wide range of both human and animal behaviors and introduced operant conditioning to the general public in his 1938 book, The Behavior of Organisms. One behavior modification technique that is widely used is positive reinforcement, which encourages certain behaviors through a system of rewards. In behavior therapy, it is common for the therapist to draw up a contract with the client establishing the terms of the reward system. As Garry Martin details in his work Behavior Modification: What It Is and How to Do It. published by Prentice-Hall in 1988. In addition to rewarding desirable behavior, behavior modification can also discourage unwanted behavior, through punishment. Punishment is the application of an aversive or unpleasant stimulus in reaction to a particular behavior. For children, this could be the removal of television privileges when they disobey their parents or teacher. The removal of reinforcement altogether is called extinction. Extinction eliminates the incentive for unwanted behavior by withholding the expected response. A widespread parenting technique based on extinction is the time-out, in which a child is separated from the group when he or she misbehaves. This technique removes the expected reward of parental attention. A IS INCORRECT This is an explanation, but not the BEST one B is INCORRECT This is Respondent or Classical Conditioning D is INCORRECT John Watson dealt with Classical Conditioning

Social work has a long history of using the ecological perspective in our clinical work. This is the basis for our "person-in-the-environment" approach. You can see the effects of this running throughout our ethical code. You know that according to the ecological perspective, this intervention ... A) should focus on the environment. B) should focus on the social agency is the key to effective treatment. C) should help clients use their own capacities. D) should resolve intrapsychic conflict.

The correct answer is C The mid to early 20th century, served as a milestone for the social work profession in adopting a family systems model to incorporate that family members are influenced equally by environmental systems with equal power. The social work discipline has expanded the ecological perspective to explain individual and group behavior. Michael Ungar, Professor of Social Work at Dalhousie University wrote in 2002, that an individual is "constantly creating, restructuring, and adapting to the environment as the environment is affecting them". The systems approach now added the social elements to the interactive process. In the 1960's and 1970's, the systems theory was expanded based on an ecological approach, breaking down the term "environment" into social determinants with varied levels of power and influence, as deemed by individual stress and need and level of connectedness. A is INCORRECT Social work focuses on the environment as it relates to the interactions with the client. To focus only on the environment would be "sterile" and unhelpful. B is INCORRECT Social work accepts that agency involvement is necessary in situations where the local support structure does not provide services, however, the agency is a "filler" and not the total package. D is INCORRECT Intrapsychic conflict is in the psychoanalytic playground and has no connection with an ecological approach, in its rawest form.

You are working with an agency whose mission statement is to help individuals recently released from a psychiatric inpatient program find work and adjust to life in the community. They provide an array of services. However, the level of prevention they operate on is BEST described as... A) primary prevention. B) secondary prevention. C) tertiary prevention. D) non-crisis intervention.

The correct answer is C It is a tertiary intervention. All interventions which occur after the problem in an attempt to keep it from happening again or ameliorating the problem to reduce the bad effects are tertiary prevention programs. B IS INCORRECT Primary intervention is a program that seeks to stop problems before they start. National vaccination and local vaccination programs are examples of primary intervention. The national movement for Voluntary Pre-School 3 hours a day for ALL children is also an example of a primary intervention. C is INCORRECT Secondary intervention is defined as locating an at-risk group and providing them services before they become involved in trouble. The national Head Start program is an example of a secondary intervention because it focuses on children who have been identified as at-risk of developmental delay. D is INCORRECT Dealing with their population, there may well be times when they have to provide crisis intervention services.

You are working with a Strategic Family Therapist who uses a number of techniques derived from the communication model in family therapy. One of the techniques in this model is called "prescribing the symptom". The BEST way to understand and describe this technique is ... A) relabeling a symptoms in order to change its meaning B) redefining a symptom in order to create systemic confusion. C) a type of paradoxical intervention to overcome resistance D) an attempt to redefine family roles.

The correct answer is C Some less complicated but often used interventions in SFT would be, prescribing the symptom, relabeling, and paradoxical interventions. Prescribing the symptom would be when the therapist attempts to exaggerate a specific symptom within the family to help the family understand how damaging that symptom is to the family. The relabeling intervention is done within the session by the therapist to change the connotation of one symptom from negative to positive. In this way the family can view the symptom in a new context or have a new conceptual understanding of the symptom. Finally a paradoxical intervention is similar to prescribing the symptom, but is a more in depth intervention than prescribing the symptom. § Initially the therapist tries to change the family's low expectations to one where change within the family can happen. § Second, the issue that the family wishes to fix is identified in a clear and concise manner. § Third, and in line with the goal-setting stage, the therapist seeks to get the family to agree to exactly what their goals are in addressing their problem. § Fourth, the therapist comes up with very specific plans for the family to address their issue. § Fifth, the therapist discredits whomever is the controlling figure of the issue. § Next the therapist replaces the controlling figure with their own authority and issues a new directive to fix the family's identified problem. The new directive for the family is usually to paradoxically do more of the problem symptom, and thereby to highlight it more within the family. § Finally the therapist learns the outcome of the directive and seeks to push the paradox even further until the family rebels, or change occurs within the family. A is INCORRECT This is not a technique of the communication model. B is INCORRECT This is not a technique of the communication model. D is INCORRECT This is not a technique of the communication model.

You are working as a discharge planning social worker for the local hospital. You have been assigned the case involving a 53 year-old man and his 78 year old mother. After a medical exam, the physician states that the mother's memory is impaired and she is incontinent of both bowel and bladder, he also states that according to her history she has fallen three times in the last 9 months, the latest fall resulting in her current hospitalization. The physician has suggested that she be placed in a nursing home. You are discussing this with the son and ask questions about support structures which he pleasantly avoids answering. He listens politely and nods occasionally. He then thanks you and tells you his mother will be fine living at his home. What is your BEST analysis for the son's response? A) the son is unwilling to discuss his family business with you. B) the son does not agree with the physician and wants to continue to care for mom C) the son is in denial about the status of his mother's health and condition. D) the son believes the doctor is trying to take away his responsibility to care for his mother.

The correct answer is C The key to understanding this question is in the sentence which deals with the mother having fallen three times and the third fall being responsible for her current hospitalization. The son may feel very obligated to attend to his mother's needs or he may be unable to understand her needs, but continued falls will quite likely result in her death. His refusal to answer questions is an aspect of his denial. If he answered your support questions, he would have to begin justifying how he was able to take care of her. Given the limited information, you need to assume denial in deciding how to continue approaching the son. A IS INCORRECT Maybe or maybe not, if discussing the family business will result in his being forced to accept his mother's deteriorating condition, then you might be correct. He may just not want anyone involved in his life. B IS INCORRECT There is no information I the question which would lead you to believe that the son disagrees with the physician or his diagnosis D IS INCORRECT There is no information given in the data that would support this idea.

You have gotten into a discussion about ego defense mechanisms with another social worker. They present you with a sheet and ask you which of the following defense mechanisms is NOT described appropriately. A) A woman who hates her mother goes out of her way to always buy her pretty things: Reaction formation B) A man with a high level of aggression becomes a local butcher: Sublimation C) A husband who is cheating but accuses his wife of having an affair to hide his behavior: Displacement: D) A young wife who goes home to visit her parents for 3 weeks and begins to act very child-like: Regression.

The correct answer is C The primary issue with displacement is the unconscious aspect of it. In the question, the behavior of accusing is conscious and goal-directed. This means it cannot be displacement. When working with a client using displacement, the recognition of the awareness of the behavior usually causes the behavior to cease. This behavior is more likely to be a simple manipulation. In Freudian psychology, displacement (German Verschiebung, 'shift' or 'move') is an unconscious defense mechanism whereby the mind redirects effects from an object felt to be dangerous or unacceptable to an object felt to be safe or acceptable.[1] The term originated with Sigmund Freud. Displacement operates in the mind unconsciously and involves emotions, ideas, or wishes being transferred from their original object to a more acceptable substitute. It is most often used to allay anxiety; and can lead to the displacement of aggressive impulses or to the displacement of sexual impulses. http://en.wikipedia.org/wiki/Displacement_(psychology) A is INCORRECT This is an accurate description of a reaction formation In psychoanalytic theory, reaction formation is a defensive process (defense mechanism) in which anxiety-producing or unacceptable emotions and impulses are mastered by exaggeration (hypertrophy) of the directly opposing tendency. http://en.wikipedia.org/wiki/Reaction_formation B is INCORRECT This is an accurate description of Sublimation In psychology, sublimation is a mature type of defense mechanism where socially unacceptable impulses or idealizations are consciously transformed into socially acceptable actions or behavior, possibly converting the initial impulse in the long term. Freud defines sublimation as the process of deflecting sexual instincts into acts of higher social valuation, being "an especially conspicuous feature of cultural development; it is what makes it possible for higher psychical activities, scientific, artistic or ideological, to play such an important part in civilized life". http://en.wikipedia.org/wiki/Sublimation_(psychology) D is INCORRECT This is an accurate description of Regression Regression, according to psychoanalyst Sigmund Freud, is a defense mechanism leading to the temporary or long-term reversion of the ego to an earlier stage of development rather than handling unacceptable impulses in a more adult way. The defense mechanism of regression, in psychoanalytic theory, occurs when thoughts are pushed back out of our consciousness and into our unconscious http://en.wikipedia.org/wiki/Regression_(psychology)

Your supervisor at a small mental health agency makes a referral to you for individual counseling. During the assessment, the client lets you know they have been a friend and acquaintance of your supervisor for more than 15 years. After you have completed your fourth session with this client, your supervisor asks you to see the client's file since she was the person who made the referral to you. Your BEST response is to... A) give your supervisor the client file. B) give your supervisor the file 'facesheet' only C) refuse to provide the file until the client signs a release of information D) terminate services with the client and refer to another agency

The correct answer is C This is what is known as a 'rock and a hard place'. Your supervisor should have disclosed her relationship with the referral up front, so you could determine if you wanted to take it. Your supervisors' request to see the client file is completely inappropriate. The reason the information should have been given up front is simple. You may report to your supervisor with questions and concerns, but on this particular case, your supervisor should have laid out an alternate supervisory chain for you. They should recuse themselves from the case and leave all information alone. Whether they intended to or not, they have put you in a very precarious situation. They have created a dual-relationship between themselves and the client and have taken no steps to control possible damage. Discuss release with the client. Get the client to sign a form, if they are willing to release information. Tell your supervisor you CANNOT provide them with any information. PS: This kind of a situation could well result in you needing to locate other employment. Be prepared. A IS INCORRECT Congratulations! You have committed an ethical violation and have set yourself up to be named in a lawsuit as a defendant. B is INCORRECT Congratulations! You have committed an ethical violation and have set yourself up to be named in a lawsuit as a defendant. D is INCORRECT The client is not the problem. You may be committing an ethical problem by 'abandoning your client.'

As a new clinical social worker you find yourself being told by your supervisor you need to be more confrontational. This seems at odds with the social work mission, until you supervisor explains the primary purpose of confrontation is to: A) demonstrate accurate understanding B) help a client change her view of a problem C) make a client aware of inconsistencies D) help the client identify alternatives to her present behavior

The correct answer is C Client's often have inconsistent views and values concerning a specific problem. This is a HUMAN problem we all fight with. Conflicts between what a client 'thinks' should be the solution and what the actual solution will be is the bread and butter of therapy. Just because we know we should do something does not mean we will act in the appropriate manner. (Think about cigarette smoking as an example) A is INCORRECT. You demonstrate an accurate understanding by reflective listening (telling the client what you think you heard them say) and by asking questions for clarification. This response back to the client is the primary component of active listening. Rather than passively saying...Uh huh... B is INCORRECT. This is the ultimate goal of many therapies and an end result you should always look to achieve. However, there are many ways to achieve it without confrontation. D is INCORRECT. This is definitely a part of therapy. Helping client's see alternatives and supporting them in their attempts to change their behavior is very powerful therapeutic intervention. But there are more ways to achieve this than through confrontation.

You are completing the first session with a women recently separated from her significant other after 7 years of co-habitation which she was hoping would culminate in marriage. She has been separated for 6 weeks and she has met "the man of her dreams." She can't stop thinking about him or talking about him to her friends. You realize she is using a common ego defense mechanism. The ego defense mechanism BEST describing her situation is ... Distortion Projection Displacement Intellectualization

The correct answer is C Displacement shifts sexual or aggressive impulses to a more acceptable or less threatening target. This allows the redirection of emotions to a safer outlet and also allows the separation of emotions from real objects. The redirection of the intense emotion toward someone or something that is less offensive and/or less threatening, with the benefit of avoiding the issue directly is very powerful. In this situation, she has displaced the sexual feelings she has for her ex-partner onto the new man in her life. It is safe to place them on him, while it is unsafe (due to rejection and emotional abandonment) to place her sexual feelings on her ex-partner. A is INCORRECT Distortion is the gross reshaping of external reality to meet internal needs. It is one of the pathological defense mechanisms. If a client is using this mechanism, you should be alert for severe pathology. B is INCORRECT Projection is a primitive form of paranoia. Projection also reduces anxiety by allowing the expression of the undesirable impulses or desires without accepting conscious awareness of them. It also allows the client to attribute his or her own unacknowledged, unacceptable and/or unwanted thoughts and emotions to someone else. D is INCORRECT Intellectualization is a form of isolation, which allows the client to concentrate on the intellectual aspects of a situation in order to distance themselves from the associated anxiety-provoking emotions. They will use the mechanism to separate emotions from ideas; entertain desires and wishes in a formal and affectively bland manner in order to fail or refuse to act upon them avoiding unacceptable emotions by focusing on the intellectual aspects. This is a very difficult defense mechanism to counter in therapy.

You are working with the son of an elderly parent. They are concerned about the father's driving and would like to pursue the necessary legal guardianship in order to keep him off the road. Of the following four circumstances he could describe regarding his father, which on would be the WORST reason for pursuing guardianship in regards to the driving issues. A) His father displays the inability to take care of his basic needs. B) His father has gotten lost while driving in familiar neighborhoods. C) His father is a danger to self or others D) His father displays advanced signs of dementia and is no longer able to manage his financial affairs

The correct answer is C If the father is a danger to himself or others, this is an issue of crisis intervention. There is no indication his danger extends to his car as there is no indication of a decline in the judgment or spatial skills needed to drive and navigate.. This is a phrase which is normally used in relation to suicidal ideations or self-hard behaviors. It will often require an involuntary commitment. But it has no impact upon his driving. HINT: When answering the questions on the test, it is important to use only the information given in the question, and not to read anything else into it. The moment you hear yourself saying, "In this situation it could be..." you are in trouble. A IS INCORRECT This may well be a good reason to seek the removal of his driving privileges. An inability to take care of basic needs is highly correlated to dementia or mental illness and strongly affects a person's capacity for safety. B IS INCORRECT This may well be a good reason to seek the removal of his driving privileges. This could be the initial signs of dementia or problems with medication interactions. However, getting lost in familiar areas could place him at risk. D IS INCORRECT Advanced signs of dementia show an impact in judgment capacity and this capacity is required to safely maneuver a vehicle.

John has withdrawn from his social circles and has begun to display rather peculiar habits when his friends come over to visit. All of his friends notice small behavior changes, which include odd statements, reference to things that "cannot be" and a comment regarding his beliefs that his dog may be listening into his telephone conversations. He is not known to use any drugs and has had no medical history. Because John is mild mannered and pleasant, his friend have felt his behavior is odd but not a major concern. When Cecelia went to visit him yesterday, he had not bathed in several days. His bird feeder was removed from the backyard and was sitting on the table. When she asked about it, he smiled pleasantly and said in a calm tone of voice, "The birds have been gathering around the bird feeder in order to spy on me and watch what I do during the day. So, I took down the birdfeeder so they can't come around anymore." He mentioned that he was happy because his brother started to call him again and they had a great conversation on the telephone that lasted for about an hour this morning. Cecelia knows that John had only one brother and he died in a car crash several years ago. Cecelia reported this to her friends and is very concerned. She calls a social worker she knows from work and they recommend John be evaluated for a psychotic disorder. Her social worker friend tells her that it is possible John is suffering from Schizophrenia. Cecelia goes online and learns the following about the onset of schizophrenia: A) It affects about 5% of the population and once treated with medications the person should have no further problems. B) It affects about 5% of the populations and most people continue to have symptoms throughout their lives. C) It affects about 1% of the population and treatment is often provided using neuroleptic medications, which can cause Tardive Dyskinesia and may have to be taken on a lifelong basis. D) It affects about 1% of the population and can cause some incapacity of social and work functioning, but the functioning incapacity is seldom profound.

The correct answer is C Schizophrenia affects about 1% of the adult population. Adequate treatment almost always requires neuroleptic medications, which can have very severe side effects, including Tardive Dyskinesia, and usually must be taken for the rest of a patient's life, or symptoms will return. A is INCORRECT 5% is too high a figure. The CHRONICITY of Schizophrenia (How chronic it is) tends to be lifelong. Once symptoms starts, it is very likely that the person will continue to have symptoms of the disorder for the rest of their life, which will need to be controlled with medications. B is INCORRECT 5% is too high a figure. However, the second half of this answer is accurate, symptoms tend to be lifelong. (High CHRONICITY) D is INCORRECT While the percentage is correct, the impact on social and work function is usually profound. The disorder is lifelong, usually requires medication, symptoms can re-occur and adjustment can be extremely difficult for the patient.

You are seeing a 23-year-old female client who appears rather manipulative. She lives at home with her mother and father and does not work or attend school. She makes the following statement during your second session, "If you really cared about me like my mother cares, you would not charge me for treatment." The client has just performed a .... A) Displacement reaction B) counter-transference reaction C) transference reaction. D) sublimation experience.

The correct answer is C The client has just used you as a movie screen and projected her mother onto you and is now transferring her emotions and desires onto the projection of her mother. As a therapist, you must withdraw the screen so the projection fails and therefore the transference is unsuccessful. This will cause the manipulation to fail and you should see the client attempt to use other mechanisms. Remember, the client is using this mechanism (set of behaviors) because it is very functional for getting their needs met. You have to assume that they are in therapy because they are running into situations where there old mechanisms no longer work as well, if at all. This is the time to explore and learn to use new mechanisms. A is INCORRECT Displacement is the mechanism whereby the user tries to reduce anxiety by "dumping" their feelings for one person (usually someone who has more power than them) onto another person (usually someone with less power than them.) B is INCORRECT A counter-transference reaction is identical in nature to a transference reaction, EXCEPT, it is the THERAPIST who projects and transfers feelings onto the CLIENT. Only the therapist can counter-transfer, and unless you are very aware of what you are doing and are well grounded in psychoanalytic theory, counter-transference is usually BAD. D is INCORRECT Sublimation is an ego defense mechanism where a client has strong feelings on a specific issue and instead of expressing them, pulls them back inside themselves and uses the "ego" energy associated with the issue to power some other issue. This can be a very positive experience or it can be a very negative one. If you have strong feelings of being persecuted and treated unjustly, and you become an advocate for the less fortunate, channeling your "ego energy" into helping them battle injustice, this would probably be a positive example of sublimation.

You are working for an agency that takes walking referrals. In the middle of your shift you have a walking referral, concerning a female who is a battered woman. She presents as scared and paranoid. Of the following actions, which intervention should you complete first ... A) Immediately begin assessment to begin case planning B) Assist the woman and identifying life patterns which should lead to abuse C) Obtain referrals for immediate safety D) Report the abuse to law-enforcement

The correct answer is C When you were dealing with the victim of domestic violence, the first thing you should do is ensure immediate safety. Immediate safety not only is required for the victim, but also of your agency and the people currently in your agency. When you are dealing with the domestic violence issue you don't know if the batter is following the victim and may storm into your agency. Safety is of the utmost concern. A IS INCORRECT There are many opportunities to begin assessment and plan for future intervention. This is a situation where the immediate action is to provide for the safety of the client. B IS INCORRECT Assisting the woman understanding her life choices and patterns will not keep her safe at the moment. This is something which can be done by a therapist much farther down the road after numerous interventions to help her overcome the abuse and violence she suffered. D IS INCORRECT Contacting the police might be something you would do in order to ensure the safety of the client, it would be only to ensure the safety of the client at the initial contact. There is plenty of time to document the abuse them and involve law-enforcement. In some jurisdictions, law enforcement may not become involved unless the victim is willing to testify.

You are seeing a female client in her thirties. Therapy is just beginning and you feel she is experiencing episodic depression. Using Aaron Beck's approach to the treatment of depression, the BEST response would be to ... A) arrange depression-inducing situations into a hierarchy. B) record his or her "automatic thoughts." C) imagine depression-inducing situations in exaggerated forms. D) instruct her to practice mood repair strategies.

The correct answer is D Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one of the therapeutic approaches within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cognitive therapy seeks to help the patient overcome difficulties by identifying and changing dysfunctional thinking, behavior, and emotional responses. This involves helping patients develop skills for modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors. Treatment is based on collaboration between patient and therapist and on testing beliefs. Therapy may consist of testing the assumptions which one makes and identifying how certain of one's usually unquestioned thoughts are distorted, unrealistic and unhelpful. Once those thoughts have been challenged, one's feelings about the subject matter of those thoughts are more easily subject to change. Beck initially focused on depression and developed a list of "errors" in thinking that he proposed could maintain depression, including arbitrary inference, selective abstraction, over-generalization, and magnification (of negatives) and minimization (of positives). An example of how CT works is this: having made a mistake at work, a man may believe, "I'm useless and can't do anything right at work." Strongly believing this then tends to worsen his mood. The problem may be worsened further if the individual reacts by avoiding activities and then behaviorally confirming the negative belief to himself. As a result, any adaptive response and further constructive consequences become unlikely, which reinforces the original belief of being "useless." In therapy, this example could be identified as a self-fulfilling prophecy or "problem cycle," and the efforts of the therapist and client would be directed at working together to change it. This is done by addressing the way the client thinks and behaves in response to similar situations and by developing more flexible ways to think and respond, including reducing the avoidance of activities and the practicing of positive activities (called Mood repair strategies). If, as a result, the patient escapes the negative thought patterns and dysfunctional behaviors, the negative feelings may be relieved over time. http://en.wikipedia.org/wiki/Cognitive_therapy Mood repair strategies offer techniques that an individual can use to shift their mood from general sadness or clinical depression to a state of greater contentment or happiness. A mood repair strategy is a cognitive, behavioral, and interpersonal psychological tool used to affect the mood regulation of an individual. Various mood repair strategies are most commonly used in cognitive therapy. They are commonly assigned as homework by therapists in order to help positively impact individuals who are experiencing dysphoria or depression. Many factors go into the effectiveness of mood repair strategies on an individual ranging from the client's self esteem to their experience with the strategy being used.] Even the way the mood repair strategy is presented (either to avoid negative moods or to pursue positive moods) may have an effect on that strategy's ability to improve mood. http://en.wikipedia.org/wiki/Mood_repair_strategies A IS INCORRECT Not a particularly helpful therapeutic process B is INCORRECT An excellent idea as an adjunct to teaching mood repair skills C is INCORRECT Not a particularly helpful therapeutic process

You have been working with a client for six sessions and they are covered by BCBS Insurance. They have elected to pay in cash rather than use their insurance benefits. Their insurance company sent you a letter requesting information about the client's progress and the current focus of therapy. Your best response is to... A) throw the letter in the trash and forget about it. B) send the insurance company a complete copy of the file. C) verify the validity of the letter and then copy and send the file. D) Send the requested information only with the client's written authorization.

The correct answer is D While you could send the information with the client's verbal authorization, it would not be wise to do so. If the client later denied giving you authorization, it is a hearsay issue and cannot be resolved. A piece of paper with a client's original signature on it, in your file is a tremendous stress reducer in the event of litigation or complaint. I usually ask my clients to sign in BLUE INK, because it does not photocopy well and is easier to prove as genuine. Even if the client signs a release at the beginning of therapy, I would encourage discussing it with them prior to release and then letting them determine if release is still their preferred choice. A is INCORRECT. Personally, I like this answer the best even though it is wrong. Perhaps is goes to my dislike of insurance companies. You must respond because the letter could have consequences for the client's continued insurance coverage and /or liability. However, you can never release information on a client without their express consent. I make it a practice to always talk to my client before I take any action on a release of Information request. B is INCORRECT. Only if you enjoy being the focus of lawsuits and complaints against your license. The client has the ultimate control over the release of their information. C is INCORRECT. Nope! Even if the letter is valid and the request for information form is appropriate, legal and binding, and your opportunity for payment is involved, the client always reserves the right to refuse to allow you to release information that does not comply with mandatory reporting requirements.

You have been asked to complete a behavioral assessment on a 12-year-old client. You know a behavioral assessment is different from a standard assessment because different areas are evaluated. Which of the following would NOT be an assumption during a behavioral assessment? A) the assessment would focus on behaviors repeatedly throughout the course of the intervention. B) the assessment would focus on specific aspects of the individual's behaviors. C) the assessment would focus on directly observable behaviors. D) would view outward behaviors as signs of an individual's underlying characteristics.

The correct answer is D A behavioral assessment is concerned with the actual observable behaviors which are being manifest by the client. Behaviorism does not even deal with any underlying characteristics in the personality structure which may be affected by or affecting the behaviors. A is INCORRECT This is a behavioral assumption in a behavioral assessment B is INCORRECT This is a behavioral assumption in a behavioral assessment D is INCORRECT This is a behavioral assumption in a behavioral assessment

The correct answer is D Asperger's is a syndrome which will have an impact on a person all throughout the life-span. The American Academy of Child and Adolescent Psychiatry describe Asperger's as... Asperger's Disorder is the term for a specific type of pervasive developmental disorder which is characterized by problems in development of social skills and behavior. In the past, many children with Asperger's Disorder were diagnosed as having autism, another of the pervasive developmental disorders, or other disorders. While autism and Asperger's have certain similarities, there are also important differences. For this reason, children suspected of having these conditions require careful evaluation. In general, a child with Asperger's Disorder functions at a higher level than the typical child with autism. For example, many children with Asperger's Disorder have normal intelligence. While most children with autism fail to develop language or have language delays, children with Asperger's Disorder are usually using words by the age of two, although their speech patterns may be somewhat odd. Most children with Asperger's Disorder have difficulty interacting with their peers. They tend to be loners and may display eccentric behaviors. A child with Asperger's, for example, may spend hours each day preoccupied with counting cars passing on the street or watching only the weather channel on television. Coordination difficulties are also common with this disorder. These children often have special educational needs. Although the cause of Asperger's Disorder is not yet known, current research suggests that a tendency toward the condition may run in families. Children with Asperger's Disorder are also at risk for other psychiatric problems including depression, attention deficit disorder, schizophrenia, and obsessive-compulsive disorder. Child and adolescent psychiatrists have the training and expertise to evaluate pervasive developmental disorders like autism and Asperger's Disorder. They can also work with families to design appropriate and effective treatment programs. Currently, the most effective treatment involves a combination of psychotherapy, special education, behavior modification, and support for families. Some children with Asperger's Disorder will also benefit from medication. The outcome for children with Asperger's Disorder is generally more promising than for those with autism. Due to their higher level of intellectual functioning, many of these children successfully finish high school and attend college. Although problems with social interaction and awareness persist, they can also develop lasting relationships with family and friends. A is INCORRECT Oppositional defiant disorder is an adolescent disorder and the effects of this diagnosis seem to almost always disperse as the patient enters their twenties. B is INCORRECT ADHD can have some lasting effects until early childhood, but more often than not children will outgrow the symptoms of ADHD. C is INCORRECT Conduct disorders can be rather severe, and some clinicians feel they can morph into an antisocial personality disorder. There may or may not be an evolution from conduct disorder to antisocial personality disorder, but you would not diagnose an adult with a conduct disorder. If they showed similar symptoms they might be diagnosed as Antisocial, Narcissistic, Intermittent Explosive Disorder, etc.

From the viewpoint of the Freudian Psychoanalyst, the purpose of interpretation as an analysis technique is to ... A) is appropriate only during the final "working through" phase of therapy. B) Useful in therapy with person's suffering from schizophrenia C) help the client develop transference D) helps the client understand the causes of his or her behaviors and beliefs.

The correct answer is D In psychoanalytic treatment, the analyst is silent as much as possible, in order to encourage the patient's free association. However, the analyst offers judiciously timed interpretations, in the form of verbal comments about the material that emerges in the sessions. The therapist uses interpretations in order to uncover the patient's resistance to treatment, to discuss the patient's transference feelings, or to confront the patient with inconsistencies. Interpretations may be either focused on present issues ("dynamic") or intended to draw connections between the patient's past and the present ("genetic"). The patient is also often encouraged to describe dreams and fantasies as sources of material for interpretation. http://medical-dictionary.thefreedictionary.com/PSYCHOANALYTIC+TREATMENT A IS INCORRECT Interpretation is used throughout the sessions. B is INCORRECT Psychoanalysis is not usually considered suitable for patients suffering from severe depression or such psychotic disorders as schizophrenia, although some analysts have successfully treated patients with psychoses. It is also not appropriate for people with addictions or substance dependency, disorders of aggression or impulse control, or acute crises; some of these people may benefit from psychoanalysis after the crisis has been resolved. http://medical-dictionary.thefreedictionary.com/PSYCHOANALYTIC+TREATMENT C is INCORRECT Transference is the name that psychoanalysts use for the patient's repetition of childlike ways of relating that were learned in early life. If the therapeutic alliance has been well established, the patient will begin to transfer thoughts and feelings connected with siblings, parents, or other influential figures to the therapist. Discussing the transference helps the patient gain insight into the ways in which he or she misreads or misperceives other people in present life.

You are a non-hispanic social worker treating a Hispanic family. TThis family recently immigrated to the United States and has been here for about 4 years. At every session, they arrive 10-15 minutes late. You are beginning to question their commitment to therapy and find this late arrival behavior irritating. The BEST way to response to this behavior is to... A) realize that being late is a form of resistance and discuss their resistance with them. B) realize that perception of time and 'lateness' may not be understood the same by their culture C) consider a referral to a social worker with a similar cultural background. D) Discuss this behavior with them and explain your feelings about it and its possible impact on therapy.

The correct answer is D Regardless of the cultural content of this interaction, the behavior (arriving late) is problematic. It reduces the time the family has in therapy and increases the length and the cost of therapy. There are many reason for clients to come late repeatedly. Often what we take for granted in our daily work is very hard for them to process. Direct discussion and a re-negotiation of expectations is appropriate here. A IS INCORRECT It may well be a form of resistance, but the question asked for your BEST response...What you need to do...understanding is not a 'do'. B is INCORRECT This may be an accurate statement; however, it does not help you as a response. Your response is an action. This is not an action, but rather an understanding. C is INCORRECT There is nothing in the question to indicate there is a problem here which would be fixed by switching therapist. Confronting the behavior is the most therapeutic response available to you.

You have been assigned to work with a female client, age 47 who has just been diagnoses with a life-limiting illness and told she should expect to have 8 more months to live. Understanding the concepts regarding Death & Dying, as put forth by Elizabeth Kubler-Ross, What would be the BEST prediction for your client's initial response? A) "Why me?" B) "If I change my life, maybe I can overcome this?" C) "It's going to be okay." D) "The test results must be inaccurate."

The correct answer is D The initial response is the first stage of the Death & Dying model. Denial — "I feel fine."; "This can't be happening, not to me." Denial is usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of possessions and individuals that will be left behind after death. Denial can be conscious or unconscious refusal to accept facts, information, or the reality of the situation. Denial is a defense mechanism and some people can become locked in this stage. A IS INCORRECT This statement is better associated with the second stage: Anger — "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?" Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. Anger can manifest itself in different ways. People can be angry with themselves, or with others, and especially those who are close to them. It is important to remain detached and nonjudgmental when dealing with a person experiencing anger from grief. B is INCORRECT This statement would be associated with the third stage: Bargaining — "I'll do anything for a few more years."; "I will give my life savings if..." The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the individual is saying, "I understand I will die, but if I could just do something to buy more time..." People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death. C is INCORRECT This statement would be associated with the fifth and final stage of the Kubler-Ross model.: Acceptance — "It's going to be okay."; "I can't fight it, I may as well prepare for it." In this last stage, individuals begin to come to terms with their mortality, or that of a loved one, or other tragic event. This stage varies according to the person's situation. People dying can enter this stage a long time before the people they leave behind, who must pass through their own individual stages of dealing with the grief. More about Elisabeth Kubler-Ross: The Kübler-Ross model, commonly known as The Five Stages of Grief, is an hypothesis first introduced by Elisabeth Kübler-Ross in her book On Death and Dying, which was inspired by her work with terminally ill patients. Kübler-Ross was inspired by the lack of curriculum in medical schools that addressed death and dying, so she started a project about death when she became an instructor at the University of Chicago medical school. This evolved into a series of seminars; those interviews, along with her previous research, led to her book. Her work revolutionized how the medical field took care of the terminally ill. Her five stages of grief have now become widely accepted. Kübler-Ross added that these stages are not meant to be complete or chronological. Her hypothesis also holds that not everyone who experiences a life-threatening or life-altering event feels all five of the responses nor will everyone who does experience them do so in any particular order. The hypothesis is that the reactions to illness, death, and loss are as unique as the person experiencing them. The stages, popularly known by the acronym DABDA, include: Denial — "I feel fine."; "This can't be happening, not to me." Denial is usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of possessions and individuals that will be left behind after death. Denial can be conscious or unconscious refusal to accept facts, information, or the reality of the situation. Denial is a defense mechanism and some people can become locked in this stage. Anger — "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?" Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. Anger can manifest itself in different ways. People can be angry with themselves, or with others, and especially those who are close to them. It is important to remain detached and nonjudgmental when dealing with a person experiencing anger from grief. Bargaining — "I'll do anything for a few more years."; "I will give my life savings if..." The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the individual is saying, "I understand I will die, but if I could just do something to buy more time..." People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death. Depression — "I'm so sad, why bother with anything?"; "I'm going to die soon so what's the point?"; "I miss my loved one, why go on?" During the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the dying person to disconnect from things of love and affection. It is not recommended to attempt to cheer up an individual who is in this stage. It is an important time for grieving that must be processed. Depression could be referred to as the dress rehearsal for the 'aftermath'. It is a kind of acceptance with emotional attachment. It's natural to feel sadness, regret, fear, and uncertainty when going through this stage. Feeling those emotions shows that the person has begun to accept the situation. Acceptance — "It's going to be okay."; "I can't fight it, I may as well prepare for it." In this last stage, individuals begin to come to terms with their mortality, or that of a loved one, or other tragic event. This stage varies according to the person's situation. People dying can enter this stage a long time before the people they leave behind, who must pass through their own individual stages of dealing with the grief.

You are working as a social worker for a school district. You have been given a case where the principal of a high school has refused a parent's request to place her son in a special education class. The reason stated by the principal is a report by the student's teacher which states that he is "lazy" and "refuses to do his work" and that he is not "a special needs kid". Your best chance of resolving this situation is to... A) discuss the student with the teacher in order to convince her the student needs to be placed in a special education class. B) talk with the mother and try to convince her that her son does not need a special education class and simply needs to adjust his attitude. C) review the file and come to your own conclusion, then submit a report to the principal. D) Arrange for an educational evaluation to determine the educational functioning level of the student and make your report based on the results.

The correct answer is D The most striking information you would need to make a determination of the students needs is not available in the question. There are laws and standards that deal with special needs children and this student needs to be evaluated to determine his need level. A teacher may have an opinion, but that will not rule the day. You need more information. You need to know this students exact functional level. You need raw and compiled data which can be supplied to you by an educational psychologist. A IS INCORRECT This approach assumes the teacher is wrong. You do not know this. You do not have the necessary information to confront the teacher's opinion. B is INCORRECT This approach assumes the mother is wrong. Again, you do not know this. You do not have the necessary information to confront the mother's beliefs. C is INCORRECT Unless state law allows you to determine student functional level, this is practicing outside the scope of your professional. Avoid this. Often as a social worker, you do not need to be the expert, just the person who gets all the information from the expert and then presents the information to everyone else.

You are a 32 -year-old social worker. You have completed your MSW and are 10 weeks shy of completing your two years of licensure supervision. You have passed the ASWB exam and are simply waiting to finish your last 10 hours of supervision with your clinical supervisor, and then file the paperwork to become fully licensed. Your agency refers you a case involving a man and woman, who are currently divorced, and are in a dispute over the custody and arrangements for their two children. Your initial meeting is with the husband. During your initial assessment, he lets you know that he feels his ex-wife will be very irate at the fact that they have not been assigned a licensed clinician. He states that his wife is an LCSW. He states she has been licensed for the past 10 years and was adamant in her referral process that she and her ex-husband receive services from a licensed clinical social worker. It becomes clear to you during your assessment with the ex-husband that the custody and arrangements for the children, are going to be a very contested issue. You have a number of concerns about the case. You have concerns about the possibility of a clinical intern providing services to a licensed clinical social worker. You decide to call your LCSW clinical supervisor and get feedback on your concerns. After detailing the situation with your supervisor, your supervisor recommends that you do the following actions: A) continue seeing the divorced couple in therapy. B) continue seeing the ex-husband in therapy and ask your office to schedule a different commission for the ex-wife. C) contact the ex-wife and discuss the situation with her and ask if she would be willing to accept you as a clinician. D) contact your office and explain to them that the case needs to be referred to a licensed provider.

The correct answer is D This is a very complex situation. The answer here is not so much an ethical consideration as it is a concern for you and your current licensure status. In the state of Florida, you are considered to be a licensed individual. However you are licensed as a Clinical Social Worker intern. In other states you would be licensed as a Master Social Worker. Both of these licensure designations are non-independent. Which means, in order for you to work, your license is tied to, and subordinate to, an Independent License, held by your Licensed Clinical Social Work Supervisor. Your license is not recognized as a license to practice independently. Assuming the information you have is correct, the ex-wife carries an independent license. The short answer here is that regardless of your expertise, regardless of your experience, and regardless of your competency, your license is not as powerful as the license of an independent clinical social worker. In any possible confrontation you will be seen as a subordinate, and as an intern. Numerous situations involving the custody arrangements of children become very contentious between all parties. There is a high probability that if you continue with this case you will be involved in some contentious situation with both parties. It would be very easy for the ex-wife to "pull rank on you" in a licensure sense. It would be quite possible for you to injure your career or possibly your chance at independent licensure status if you were to continue working with this case. The most appropriate thing to do would be to turn the case over to your agency and have them assign a licensed professional. A is INCORRECT. While there is no specific ethical violation for seeing this couple in therapy, there is nothing positive that can come out of it for you. All relationships, as they breakup, can become volatile. People become angry and are looking for resolution and retribution. Whether you like it or not, there is a form of bigotry among licensed professionals. Fully independent licenses are more powerful than intern licenses. And if a confrontation were to occur you would be placing your subordinate license against an independent license. Chances are very good you would lose. Even if you did not lose, you could end up in the middle of an investigation that could take several months to sort out all the particulars. The best thing you can do is to refer this back to your agency and walk away. B is INCORRECT The largest problem you will have been the situation, if you want to continue to provide services, would be to place yourself in an adversarial position between the divorcing couple. This would allow you to be triangulated between the two parties. If you were to choose to provide services to the husband only and ask that the month the wife receive a separate therapist, you would only be exacerbated the triangulation. You would also allow the couple to continue their fight through two different proxies, yourself and the other therapist. C is INCORRECT Whether the ex-wife wants a licensed clinician because she feels they would be able to better handle the situation, or because they felt that they might have more control over the clinician, it is highly unlikely that the wife is going on accept you as a clinical peer. She will probably see you as inferior in training and skill. No good can come to you in providing services in the situation. Refer the case back to your agency and walk away.

You have a student ask you about Lawrence Kohlberg's theory of moral development. They state that they know Kohlberg viewed his moral development as being driven by... A) family as the first driver of moral development. B) innate biological drives and are universal C) related specifically to peer interactions. D) school and education rules and religious teachings.

The correct answer is A Dr. Anita E. Woolfolk , in her work, Four strategies for fostering character development in children: Readings and Cases in Educational Psychology. Published by Allyn & Bacon in 1993 identified Kohlberg's ideas of moral development as ... based on the premise that at birth, all humans are void of morals, ethics, and honesty. He identified the family as the first source of values and moral development for an individual. He believed that as one's intelligence and ability to interact with others matures, so does one's patterns of moral behavior. Kohlberg based his ideas of moral reasoning on Piaget's moral reasoning and morality of cooperation. He described three main levels of moral development with two stages in each level. Level 1 ------- Preconventional Morality Stage 1 - Obedience and Punishment The earliest stage of moral development is especially common in young children, but adults are also capable of expressing this type of reasoning. At this stage, children see rules as fixed and absolute. Obeying the rules is important because it is a means to avoid punishment. Stage 2 - Individualism and Exchange At this stage of moral development, children account for individual points of view and judge actions based on how they serve individual needs. In the Heinz dilemma, children argued that the best course of action was the choice that best-served Heinz's needs. Reciprocity is possible at this point in moral development, but only if it serves one's own interests. Level 2 ----- Conventional Morality Stage 3 - Interpersonal Relationships Often referred to as the "good boy-good girl" orientation, this stage of moral development is focused on living up to social expectations and roles. There is an emphasis on conformity, being "nice," and consideration of how choices influence relationships. Stage 4 - Maintaining Social Order At this stage of moral development, people begin to consider society as a whole when making judgments. The focus is on maintaining law and order by following the rules, doing one's duty and respecting authority. Level 3 ----- Postconventional Morality Stage 5 - Social Contract and Individual Rights At this stage, people begin to account for the differing values, opinions and beliefs of other people. Rules of law are important for maintaining a society, but members of the society should agree upon these standards. Stage 6 - Universal Principles Kolhberg's final level of moral reasoning is based upon universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules. Biography: Anita Woolfolk Hoy received her BA Magna Cum Laude in 1969 from the University of Texas at Austin, with a major in Psychology and a minor in Chemistry. In 1972 she was awarded a Ph.D. in Educational Psychology from the same university. From 1973 to 1993 she was on the faculty of the Department of Educational Psychology (Chair 1990-1993) of the Graduate School of Education, Rutgers University. Currently she is a Professor in the College of Education, The Ohio State University, Columbus, Ohio. Her professional offices include Vice-President for Division K (Teaching & Teacher Education) of the American Educational Research Association and President of Division 15 (Educational Psychology) of the American Psychological Association. She is married to Wayne K. Hoy, the Novice Fawcett Chair in Educational Administration at The Ohio State University. Together have completed the 3rd edition of Instructional Leadership: A Research-Based Guide to Learning in Schools (Allyn & Bacon) and conduct research on teacher and school efficacy. They have three children: Wayne, President of Advanced Software Products; Kelly, a teacher at The Phillips Brooks School in Menlo Park, CA; and Liz, a student in Columbus, OH. Their insights about education are frequently volunteered and greatly appreciated. B is INCORRECT Kohlberg dismissed innate biological drives. C is INCORRECT Peer interactions may shape morals, but are not the drivers of moral development. D is INCORRECT School and Church may shape moral development, but do not drive it.

From the work of Freud, a group of psychoanalyst arose who would become known as the Neo-Freudians. These include Eric Fromm, Karen Horney, Harald Schultz-Hencke and H.S. Sullivan. When you are reviewing the differences between the Neo-Freudians thoughts and the Classical Psychoanalysis of Freud, the PRIMARY difference is... A) were unconcerned with life experiences B) placed greater emphasis on the impact of social influences on ego functions C) focused on an individual's "innate wisdom" D) placed greater emphasis on instinctual and unconscious forces.

The correct answer is B An interest in the social approach to psychodynamics was the major theme linking the so-called Neo-Freudians. Adler had perhaps been 'the first to explore and develop a comprehensive social theory of the psychodynamic self'; and 'after Adler's death, some of his views...came to exert considerable influence on neo-Freudian theory': indeed, it has been suggested of 'Horney and Sullivan...that these theorists could be more accurately described as "neo-Adlerians" than "neo-Freudians"'. As early as 1932, however, Fromm had been independently regretting that psychoanalysts 'did not concern themselves with the variety of life experience...and therefore did not try to explain psychic structure as determined by social structure'. Horney too 'emphasised the role culture exerts in the development of personality and downplayed the classical driven features outlined by Freud'. Erikson for his part stressed that 'psychoanalysis today is...shifting its emphasis...to the study of the ego's roots in social organisation', and that its method should be 'what H. S. Sullivan called "participant", and systematically so'. Harald Schultz-Hencke (1892-1953), doctor and psychotherapist, was thoroughly busy with questions like impulse and inhibition and with the therapy of psychoses as well as the interpretation of dreams. He was against't the libido freudian theory and also working with Prof. Matthias Göring in his institute (Deutsches Institut für psychologische Forschung und Psychotherapie). He created the name "neopsychoanalyse" in 1945. The 'Neo-Freudian revolt against the orthodox theory of instincts' was thus anchored in a sense of what Sullivan termed '"our incredibly culture-ridden life"'. By their writings, and 'in accessible prose, Fromm, Horney, and others mounted a cultural and social critique which became almost conventional wisdom'. Through informal and more formal institutional links, such as the William Alanson White Institute, as well as through likeness of ideas, the Neo-Freudians made up a cohesively distinctive and influential psychodynamic movement. http://en.wikipedia.org/wiki/Neo-Freudianism A IS INCORRECT Both were very concerned with life experiences C IS INCORRECT Not a cohesive issue with the Neo-Freudians D IS INCORRECT Both placed a rather strong emphasis on instinctual and unconscious drives.

You have a social work intern in your office and she has been reading about different therapies. She is slightly confused about Client-Centered Therapy and the work of Carl Rogers. She is unsure how a client centered therapist would approach the concept of client diagnosis. You know the BEST answer is... A) a task shared equally by the therapist and client. B) probably unnecessary and possibly detrimental. C) the initial step in therapy. D) a process ongoing throughout therapy.

The correct answer is B Carl Rogers' Client Centered Therapy : Under the microscope Sixty years ago, psychologist Carl Rogers introduced a new approach to psychotherapy that ran contrary to the theories dominant at the time. His method, client-centered therapy, still offers a contrast to most approaches to therapy today, says the January issue of the Harvard Mental Health Letter. Client-centered therapists rarely ask questions, make diagnoses, provide interpretations or advice, offer reassurance or blame, agree or disagree with clients, or point out contradictions. Instead, they let clients tell their own stories, using the therapeutic relationship in their own way. In client-centered therapy, the therapist listens without trying to provide solutions. The therapist must create an atmosphere in which clients can communicate their feelings with certainty that they are being understood rather than judged, says the Harvard Mental Health Letter. This permissive indirect approach makes clients more aware of aspects of themselves that they have been denying, say its supporters. The aim is to free clients of the sense that they are under the influence of forces beyond their control. Client Centered Therapy Critics Client-centered therapy has its critics — for the vagueness of its principles, its antipathy to diagnosis, and its emphasis on the client's self-evaluation as the way to judge the outcome of therapy. Client-centered therapy may work less well with people who find it difficult to talk about themselves or have a mental illness that distorts their perceptions of reality, says the Harvard Mental Health Letter. Today, only a small proportion of mental health professionals regard themselves as taking the client-centered therapy approach. "But the principles may have influenced the practice of many therapists," says Harvard Mental Health Letter editor Dr. Michael Miller. "Its legacy may persist less as a specific technique than as a background influence." http://www.health.harvard.edu/press_releases/client_centered_therapy A IS INCORRECT If a client centered therapist decided a diagnosis was necessary, this is probably how they would go about getting it. C is INCORRECT Absolutely not! D is INCORRECT Again - No!

As a generalization regarding clients who suffer from drug or alcohol addiction, which of the following statements regarding POOR TREATMENT PROGNOSIS is the MOST accurate? A) When they suffer from a concurrent anxiety disorder B) When they are homeless or unemployed C) When they are over 50 years old D) When they are also diagnosed with a Borderline Personality Disorder

www.MyMSW.info FREE LCSW Exam QUESTION Inbox x MyMSW.Info [email protected] via mail60.atl31.mcdlv.net Jan 8 to me a mother and father who have an 8-year-old male child. Is this email not displaying correctly? View it in your browser. MyMSW.info Banner January 7, 2014 JUST RELEASED !!! 150 Questions Every Social Worker Should Know BUY IT TODAY ! Have a friend who needs help? Use the 'forward to a friend link' at the bottom of the page. Your daily question for Exam Prep on the LCSW - ASWB® Clinical EXAM! 642 Section: Clinical You are working with a mother and father who have an 8-year-old male child. During the first family session you notice the child does not seem very expressive. Each time the child begins to express emotions the parents jump in and squash it. Twice while describing an incident at school the child becomes emotional and then parents tell him "get control of yourself" and "boys don't whine." With this type of parenting you would expect to see which of the following symptoms currently? A) high anxiety levels. B) eating disorders. C) psychomotor problems. D) acting-out behavior and somatization MyMSW.info Study Materials Save the Planet! Save trees! Save Money! Another 100 Questions Every Social Worker Should Know... JUST released as a Kindle E-BOOK! http://www.amazon.com/Another-Questions-Social-Worker-ebook/dp/B007ZVDMTI/ref=sr_1_1?ie=UTF8&qid=1336659066&sr=8-1 _______________________________________ Exam Prep Material The correct answer is A From age 6 to 12 a child is learning "methods of interacting" and "competence at interacting with others." This requires they learn to cope with their emotions. During this stage of development the goal is to create and develop new skills and knowledge. If we are allowed to do this, we develop a sense of "industry" or competence. Part of this stage is the development of control over our emotions, especially when dealing with other people. If the child fails to learn how to resolve feelings, they can develop a sense of inadequacy and inferiority. This will almost certainly damage self-esteem and competence. The parents are interfering with his ability to learn how to handle his emotions. Without an external outlet, he is likely to compensate for this lack of training in the form of internalized anxiety and fear. B is INCORRECT Eating disorders follow a similar path but there is no indication that there is a problem with food. It is possible, if this were a female instead of a male, they might begin to exercise control over themselves and their family, by controlling their food intact and /or binging and purging. C is INCORRECT Psychomotor problems are not usually associated with a compensation mechanism at this age. If you see psychomotor issues, it would be best to get a medical evaluation, preferably from a neurologist, immediately. D is INCORRECT Given the data in the question, this would not seem to be a problem, however, if this were to continue unabated, you might certainly begin to see this type of behavior by age 12 or 13. This boy will eventually learn to compensate for having their emotions squashed, but it will probably be a "non-productive" form of compensation. "not affiliated with Association of Social Work Boards (ASWB®). follow on Twitter | friend on Facebook | forward to a friend Copyright © 2014 Mymsw.info, All rights reserved. You signed up for the Free Question of the Day at www.MyMSW.info Our mailing address is: Mymsw.info 2908 whirl a way trail Tallahassee, FL 32309 Add us to your address book Email Marketing Powered by MailChimp unsubscribe from this list | update subscription preferences | view email in browser MyMSW.Info [email protected] via mail168.atl21.rsgsv.net Jan 8 to me generalization regarding clients who suffer from drug or alcohol addiction Is this email not displaying correctly? View it in your browser. MyMSW.info Banner January 8, 2014 JUST RELEASED !!! 150 Questions Every Social Worker Should Know BUY IT TODAY ! Have a friend who needs help? Use the 'forward to a friend link' at the bottom of the page. Your daily question for Exam Prep on the LCSW - ASWB® Clinical EXAM! 643 Section: Clinical As a generalization regarding clients who suffer from drug or alcohol addiction, which of the following statements regarding POOR TREATMENT PROGNOSIS is the MOST accurate? A) When they suffer from a concurrent anxiety disorder B) When they are homeless or unemployed C) When they are over 50 years old D) When they are also diagnosed with a Borderline Personality Disorder MyMSW.info Study Materials Save the Planet! Save trees! Save Money! Another 100 Questions Every Social Worker Should Know... JUST released as a Kindle E-BOOK! http://www.amazon.com/Another-Questions-Social-Worker-ebook/dp/B007ZVDMTI/ref=sr_1_1?ie=UTF8&qid=1336659066&sr=8-1 _______________________________________ Exam Prep Material The correct answer is B Alcohol and drug addiction are extremely complex situations. One of the primary issues is life structure or lack of it. When a client is homeless or unemployed, they are lacking in structure. Boundaries, which are normally weak and unhealthy in substance abusing clients, are minimal or non-existent in this situation. There is no reason to look forward to a different day" and no concrete reason "Not to use." A is INCORRECT A concurrent anxiety disorder may well cause some problems with their addiction, however, it can be dealt with in treatment and does not necessarily correlate to a poor prognosis. C is INCORRECT Age does not correlate with poor prognosis. If anything, common sense would indicate that age would probably correlate with successful treatment. One of the tenets of substance abuse counseling is that you treat when you can and you treat every time someone comes back. It is not unusual for the addict to "fall off the wagon". Once they do and they come back to treatment, you pick up where they left off. They have a greater chance to absorb the lessons of treatment. D is INCORRECT It is a major mistake to diagnose or try to treat a personality disorder during an addiction. The basic concepts of addiction would indicate weak boundaries and poor ego strength. These are the hallmarks of both the addict and the individual with a personality disorder. Treat the addiction first and the "personality disorder" may go away, because it was never there to begin with.

You are discussing personality disorders with a younger colleague. They say they seem really confusing. You know personality disorders to be rather simple when you break down the initial diagnostic criteria for them and them separate them into their 3 primary groupings. Because of this, you know the BEST answer about personality disorders is... A) By definition, personality disorders must be present continuously since childhood. B) The majority of people diagnosed with one personality disorder meet the diagnostic criteria for at least one other personality disorder. C) Since personality disorders are treated differently than acute disorders, medical conditions, or life stressors by the DSM-IV, they are placed on Axis III. D) Because they are more debilitating, people with personality disorders seek treatment more often than people with acute disorders.

The correct answer is A The DSM-IV lists General diagnostic criteria for a personality disorder, which must be met in addition to the specific criteria for a particular named personality disorder. This requires that there be (to paraphrase): · An enduring pattern of psychological experience and behavior that differs prominently from cultural expectations, as shown in two or more of: cognition (i.e. perceiving and interpreting the self, other people or events); affect (i.e. the range, intensity, lability, and appropriateness of emotional response); interpersonal functioning; or impulse control. · The pattern must appear inflexible and pervasive across a wide range of situations, and lead to clinically significant distress or impairment in important areas of functioning. · The pattern must be stable and long-lasting, have started as early as at least adolescence or early adulthood. · The pattern must not be better accounted for as a manifestation of another mental disorder, or to the direct physiological effects of a substance (e.g. drug or medication) or a general medical condition (e.g. head trauma). The ICD-10 'clinical descriptions and diagnostic guidelines' introduces its specific personality disorder diagnoses with some general guideline criteria that are similar. To quote: · Markedly disharmonious attitudes and behavior, generally involving several areas of functioning; e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others; · The abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness; · The abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations; · The above manifestations always appear during childhood or adolescence and continue into adulthood; · The disorder leads to considerable personal distress but this may only become apparent late in its course; · The disorder is usually, but not invariably, associated with significant problems in occupational and social performance. The ICD adds: "For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations." In clinical practice, individuals are generally diagnosed by an interview with a psychiatrist based on a mental status examination, which may take into account observations by relatives and others. One tool of diagnosing personality disorders is a process involving interviews with scoring systems. The patient is asked to answer questions, and depending on their answers, the trained interviewer tries to code what their responses were. This process is fairly time consuming. http://en.wikipedia.org/wiki/Personality_disorders B IS INCORRECT Because of the way we break down the symptoms of a personality disorder, some behaviors seem to cross between several disorders, but labeling a person with multiple disorders is seldom clinically useful. Remember, we diagnose to determine best possible treatment. If a diagnosis does not serve this purpose, it is probably useless. C IS INCORRECT Personality disorders are always coded on Axis II D IS INCORRECT Just the opposite is true. Since the behaviors associated with a personality disorder are entrenched (since early life) and usually ego-syntonic (useful and comfortable for the protection of the ego) people who display personality disorder behavior do not readily seek treatment. Addition information about Personality Disorders: American Psychiatric Association The Diagnostic and Statistical Manual of Mental Disorders (currently the DSM-IV) lists ten personality disorders, grouped into three clusters in Axis II. The DSM also contains a category for behavioral patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder. This category is labeled Personality disorder not otherwise specified. Cluster A (odd or eccentric disorders) · Paranoid personality disorder: characterized by irrational suspicions and mistrust of others. · Schizoid personality disorder: lack of interest in social relationships, seeing no point in sharing time with others, anhedonia, introspection. · Schizotypal personality disorder: characterized by odd behavior or thinking. Cluster B (dramatic, emotional or erratic disorders) · Antisocial personality disorder: a pervasive disregard for the rights of others, lack of empathy, and (generally) a pattern of regular criminal activity. · Borderline personality disorder: extreme "black and white" thinking, instability in relationships, self-image, identity and behavior often leading to self-harm and impulsivity. · Histrionic personality disorder: pervasive attention-seeking behavior including inappropriately seductive behavior and shallow or exaggerated emotions. · Narcissistic personality disorder: a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Characterized by self-importance, preoccupations with fantasies, belief that they are special, including a sense of entitlement and a need for excessive admiration, and extreme levels of jealousy and arrogance. Cluster C (anxious or fearful disorders) · Avoidant personality disorder: pervasive feelings of social inhibition and social inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction. · Dependent personality disorder: pervasive psychological dependence on other people. · Obsessive-compulsive personality disorder (not the same as obsessive-compulsive disorder): characterized by rigid conformity to rules, moral codes and excessive orderliness.

You are seeing clients for a private practice and there is no limit to the number of times you can see the client if there is need for services. You ask about this and are told the practice provides services for capitated fees. Your BEST understanding of this is... A) physicians receive a fixed dollar amount over a specific period of time to cover the medical needs of a fixed number of patients. B) the practice uses a PPO model and the providers use a fee-for-service method. C) the practice modifies their fees based on their patients' ability to pay. D) the practice requires payment up-front and patients bill their insurance companies.

The correct answer is A CAPITATION Defined formally, capitation is a fixed sum per person paid in advance of the coverage period to a healthcare entity in consideration of its providing, or arranging to provide, contracted healthcare services to the eligible person for the specified period. For example, a hospital may receive a capitation premium of $50 per month for every member of a particular health plan. In return for this capitation (or per capita rate), the hospital agrees to provide hospital services to all members of that health plan, regardless of what the actual cost of these services ends up being. In the example above, the risk to the hospital should be clear: it receives a fixed premium ("capitation") in return for services which may cost more or less than that premium. In effect, the hospital has become a mini-insurance company which receives a guaranteed cost premium in return for an agreement to provide services whose value is not initially known. Among the different types of health insurance plans, capitation and its attendant risks can be pushed down to various levels. http://www.casact.org/pubs/dpp/dpp97/97dpp097.pdf B IS INCORRECT In a classic PPO structure, the PPO insurance company assumes and retains all insurance risk. The healthcare providers are paid on a fee-for-service basis, typically pre-negotiated at a discount off of normal charges, The providers bear little risk except for the fact that they have agreed to receive lower rates in the hopes that their volume of business will increase. http://www.casact.org/pubs/dpp/dpp97/97dpp097.pdf C IS INCORRECT This is a sliding scale model D IS INCORRECT This is a CASH for services model

You have been asked to consult with another clinical social worker on a client. The social worker feels a diagnosis of Social Phobia is appropriate over a diagnosis of Agoraphobia. You know that the difference between these two diagnoses is BEST described as ... A) agoraphobia involves distress over the possibility of experiencing severe anxiety or a panic attack. B) agoraphobia involves a fear of acting in a way that will bring about humiliation or embarrassment. C) agoraphobia involves a fear of numerous social situations, while social phobia entails a fear of a single circumscribed social situation. D) agoraphobia involves a fear of places or situations, while social phobia entails a fear of people.

The correct answer is D The essential feature of Agoraphobia is anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile. A person who experiences agoraphobia avoids such situations (e.g., travel is restricted) or else they endure with significant distress or with anxiety about having a Panic Attack or panic-like symptoms. More information about Agoraphobia Agoraphobia (from Greek ἀγορά, "marketplace"; and φόβος/φοβία, -phobia) is an anxiety disorder characterized by anxiety in situations where the sufferer perceives the environment to be difficult or embarrassing to escape. These situations include, but are not limited to, wide-open spaces, as well as uncontrollable social situations such as may be met in shopping malls, airports, and on bridges. Agoraphobia is defined within the DSM-IV TR as a subset of panic disorder, involving the fear of incurring a panic attack in those environments. The sufferer may go to great lengths to avoid those situations, in severe cases becoming unable to leave their home or safe haven. Although mostly thought to be a fear of public places, it is now believed that agoraphobia develops as a complication of panic attacks. However, there is evidence that the implied one-way causal relationship between spontaneous panic attacks and agoraphobia in DSM-IV may be incorrect. Onset is usually between ages 20 and 40 years and more common in women. Approximately 3.2 million, or about 2.2%, of adults in the US between the ages of 18 and 54, suffer from agoraphobia. Agoraphobia can account for approximately 60% of phobias. Studies have shown two different age groups at first onset: early to mid twenties, and early thirties. http://en.wikipedia.org/wiki/Agoraphobia A IS INCORRECT This is only part of the diagnosis for Agoraphobia. B IS INCORRECT This is a symptom of Social Phobia More information about Social Phobia Social anxiety disorder is characterized by the presence of all of the following symptoms: A significant and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people. The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent. The feared social or performance situations are avoided or else are endured with intense anxiety or distress. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia. In individuals under age 18 years, the duration is at least 6 months. The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder. If a general medical condition or another mental disorder is present, the fear in the first criteria is unrelated to it, e.g., the fear is not of Stuttering, trembling in Parkinson's disease, or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia Nervosa C IS INCORRECT This answer is incorrect on several fronts.

You are working with a younger social worker and have been asked a question regarding personality disorders. Of the following personality disorders, which is four to five times more likely to be diagnosed in male patients than in female patients. A) borderline B) narcissistic C) obsessive-compulsive D) antisocial

The correct answer is D The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV-TR), defines antisocial personality disorder (in Axis II Cluster B) as:[1] A) There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three or more of the following: failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest; deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure; impulsiveness or failure to plan ahead; irritability and aggressiveness, as indicated by repeated physical fights or assaults; reckless disregard for safety of self or others; consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations; lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another; B) The individual is at least age 18 years. C) There is evidence of conduct disorder with onset before age 15 years. D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode. The individual must be at least 18 years of age to be diagnosed with this disorder (Criterion B), but those diagnosed with ASPD as adults were commonly diagnosed with conduct disorder as children. The prevalence of this disorder is 3% in males and 1% from females, as stated in the DSM IV-TR. http://en.wikipedia.org/wiki/Antisocial_personality_disorder A is INCORRECT The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV-TR), a widely used manual for diagnosing mental disorders, defines borderline personality disorder (in Axis II Cluster B) as: A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-injuring behavior covered in Criterion 5 A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. Identity disturbance: markedly and persistently unstable self-image or sense of self. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, excessive spending, eating disorders, binge eating, substance abuse, reckless driving). Note: Do not include suicidal or self-injuring behavior covered in Criterion 5 Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars or picking at oneself (excoriation). Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days). Chronic feelings of emptiness Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. http://en.wikipedia.org/wiki/Borderline_personality_disorder B is INCORRECT The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines narcissistic personality disorder (in Axis II Cluster B) as: A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) Requires excessive admiration Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others Is often envious of others or believes others are envious of him or her Shows arrogant, haughty behavior or attitudes. It is also a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. http://en.wikipedia.org/wiki/Narcissistic_personality_disorder C is INCORRECT OCPD was first included in DSM-II, and was in large based on Sigmund Freud's notion of the obsessive personality or anal-erotic character style characterized by orderliness, parsimony, and obstinacy. The Diagnostic and Statistical Manual of Mental Disorders fourth edition, (DSM IV-TR = 301.4), a widely used manual for diagnosing mental disorders, defines obsessive-compulsive personality disorder (in Axis II Cluster C) as: A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts. It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. The diagnostic criteria for OCPD have gone through considerable changes with each DSM modification. For example, the DSM-IV stopped using two criteria present in the DSM-III-R, constrained expression of affection and indecisiveness, mainly based on reviews of the empirical literature's that found these traits did not contain internal consistency. To receive a diagnosis of OCPD, a person must meet four or more of the following characteristics listed in the DSM-IV-TR (2000): is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone; demonstrates perfectionism that hampers with completing tasks; is extremely dedicated to work and efficiency to the elimination of spare time activities; is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values; is not capable of disposing worn out or insignificant things even when they have no sentimental meaning; is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things; takes on a stingy spending style towards self and others; and shows stiffness and stubbornness.

You are working with a clinical social worker who has been trained in structural family therapy. The new case you are working on is an enmeshed family of four, in which the mother is over-controlling, yells, nags and confronts her 14 and 16-year-old daughters. The FIRST thing a structural family therapist would do is... A) provide a paradoxical intervention by telling the mother to set aside an hour a day to nag her daughters. B) create a structural diagram of the family to determine interventions. C) help the mother develop insight into how her yelling elicits oppositional behaviors from her children. D) create a role play where the daughters treat the mother in the same fashion they are treated.

The correct answer is B According to Michael P. Nichols & Richard C. Schwartz in their work FAMILY THERAPY Concepts and Methods, 6/E published by Allyn & Bacon © 2004 Structural family therapists use a few simple symbols to diagram structural problems and these diagrams usually make it clear what changes are required. An important aspect of structural family problems is that symptoms in one member reflect not only that person's relationships with others, but also the fact that those relationships are a function of still other relationships in the family. If Johnny, aged sixteen, is depressed, it's helpful to know that he's enmeshed with his mother. Discovering that she demands absolute obedience from him and refuses to let him develop his own thinking or outside relationships helps to explain his But that's only a partial view of the family system. Why is the mother enmeshed with her son? Perhaps she's disengaged from her husband. Perhaps she's a widow who hasn't found new friends, a job, or other interests. Helping Johnny resolve his depression may best be accomplished by helping his mother satisfy her need for closeness with her husband or friends. Because problems are a function of the entire family structure, it's important to include the whole group for assessment. A is INCORRECT Paradoxical interventions may be appropriate after you determine a structure and avenue for treatment, but it would not be the "first" thing you would do. C is INCORRECT Insight development is more in the working range of the psychoanalysts. Structural family therapists believe that problems are maintained by dysfunctional family organization. Therefore therapy is directed at altering family structure so that the family can solve its problems. The goal of therapy is structural change; problem-solving is a by-product of this systemic goal. (Nichols 2004, p. 186) D is INCORRECT Maybe later, but definitely not before you understand the structure of the family.

You are working with Jodi and during your second session, she states that she is a left- handed individual and therefore is more sensitive, more creative and more emotional than many other people who are right handed. You ask her how she knows this and she says, "I just heard it and it fits me." You are aware that she may be correct according to a theory created by Nobel-prize-winners Roger Sperry and Robert Ornstein. This theory is known as... A) Brain Schism Theory B) Brain Lateralization Theory C) Inherent Lobe Theory D) Corpus Collosum Effect

The correct answer is B Brain Lateralization Theory is the idea that the two halves of the brain's cerebral cortex -- left and right -- execute different functions. The lateralization theory -- developed by Nobel-prize-winners Roger Sperry and Robert Ornstein -- helps us to understand our behavior, our personality, our creativity, and our ability to use the proper mode of thinking when performing particular tasks. (The cerebral cortex is a part of the brain that exists only in humans and higher mammals, to manage our sophisticated intellect.) The two halves ("hemispheres") are joined by the Corpus Collosum. This is a bundle of more than 200 million nerve fibers, which transmit data from one hemisphere to the other so that the two halves can communicate. Although this nerve connection would seem to be vital, it is severed in a surgical procedure for some people who have epilepsy. The Corpus Collosum is up to 40 percent larger in women than it is in men. We can specify the functions of the two hemispheres. (The following descriptions apply to right-handed people; for left-handed people, this information is reversed; for example, it is the right hemisphere, which processes analytical thought.) The left hemisphere specializes in analytical thought. The left hemisphere deals with hard facts: abstractions, structure, discipline and rules, time sequences, mathematics, categorizing, logic and rationality and deductive reasoning, knowledge, details, definitions, planning and goals, words (written and spoken and heard), productivity and efficiency, science and technology, stability, extraversion, physical activity, and the right side of the body. The left hemisphere is emphasized in our educational system and in our society in general, for better or for worse; as Marshall McLuhan speculated, "The day when bureaucracy becomes right hemisphere will be utopia." The right hemisphere specializes in the "softer" aspects of life. This includes intuition, feelings and sensitivity, emotions, daydreaming and visualizing, creativity (including art and music), color, spatial awareness, first impressions, rhythm, spontaneity and impulsiveness, the physical senses, risk-taking, flexibility and variety, learning by experience, relationships, mysticism, play and sports, introversion, humor, motor skills, the left side of the body, and a holistic way of perception that recognizes patterns and similarities and then synthesizes those elements into new forms. http://www.theorderoftime.com/politics/cemetery/ stout/h/brain-la.htm A is INCORRECT This is a "made up" phrase C is INCORRECT This is a "made up" phrase D is INCORRECT This is a "made up" phrase

You have been assigned to help a family who have just received been told their child has an IQ of 32. They are very distressed and want to know what they can expect their child to do in the future. They want to make sure their expectations for their child are appropriate to their child's abilities. You know that the BEST statement which describes the long-term prognosis for their child is... A) academic skills up to the second grade level, adaptation to community living in a supervised setting B) minimum motor development and complete care for physical needs and maintenance of hygiene. C) basic self-care skills, ability to talk and read "survival" words, ability to perform simple tasks in a closely supervised setting D) communication and social skills, academic skills up the sixth grade level, vocational skills for minimum self-support, community living

The correct answer is C An intellectual disability, formerly referred to as "mental retardation", is not an inherent trait of any individual, but instead is characterized by a combination of deficits in both cognitive functioning and adaptive behavior. The severity of the intellectual disability is determined by the discrepancy between the individual's capabilities in learning and in and the expectations of the social environment. It should be noted that while the term "mental retardation" is still widely used within education and government agencies; however, many advocacy groups feel that this label has too many negative connotations. The newer terms of intellectual disability or developmental disability are becoming far more accepted and prevalent within the field. Characteristics The large majority of individuals considered intellectually disabled are in the mild range with an IQ of 50 to 70. For many of these individuals, there is no specific known cause of their developmental delays. The validity and reliability of the IQ tests used with these individuals are often in question. However, if a student is evaluated and scores an IQ of 70 or lower, he or she is considered to have an intellectual disability. The problems with these labels are that the guidelines can be altered, as in the 1970s when eligibility guidelines shifted and thousands that were previously "mentally retarded" were miraculously "cured" by changing federal regulation. The two characteristics shared in varying degrees by all individuals with intellectual disabilities are limitations in intellectual functioning and limitations in adaptive behavior. Limitations in intellectual functioning often include difficulties with memory recall, task and skill generalization, and these students may demonstrate a tendency towards low motivation and learned helplessness. Issues in adaptive behavior may include difficulties with conceptual skills, social skills and practical skills. Individuals with intellectual disabilities also often exhibit deficits in self-determination skills as well, including skill areas such as choice making, problem solving, and goal setting. http://www.projectidealonline.org/intellectualDisabilities.php The Severe Range of an intellectual disability (IQ range of 20-35) 0 to 5 years (preschool years) There is minimum development in motor skills like head holding/sitting /walking/speech. The child is unable to profit from training and still needs care like a toddler of 18 months. 6 to 20 years The child profits from systematic habit training for self-care and learns to communicate personal needs and is capable of understanding and executing simple commands. The child in general has capabilities of a 6 years old normal child. http://www.arctelediagnosis.com/articles.asp?sno=21 A is INCORRECT This scenario better describes the moderate range of an intellectual disability (IQ range of 35-55) 0 to 5 years (preschool years) The child develops motor skills like a normal child of three. Speech development although slow but the child learns to communicate and profits from training for skills needed for self-help. 6 to 20 years The child develops capabilities like a normal child of 8 years. The child can be educated up to grade two in academic subjects and master manual vocational skills. The child can travel alone in familiar places and also learns social skills. Adult 21 years and above Persons are capable of self-maintenance in unskilled and semiskilled work under supervision but still require supervision for management of finances and relationships. http://www.arctelediagnosis.com/articles.asp?sno=21 B is INCORRECT This scenario better describes the profound range of an intellectual disability (IQ range of <20) 0 to 5 years (preschool years) Child needs nursing care like an infant under one year of age 6 to 20 years There is minimum motor development. The child still needs care for physical needs and maintenance of hygiene. Adult 21 years and more The person still needs nursing care although with intense training with patience and love the person can achieve minimal skill for self-care. http://www.arctelediagnosis.com/articles.asp?sno=21 D is INCORRECT This scenario better describes the mild range of an intellectual disability (IQ range of 55-70) 0 to 5 years (preschool years) The child has normal motor development but slight delay in speech development. Such children are often not distinguishable from children with normal intelligence. 6 to 20 years This child can be trained to acquire academic skills up to grade sixth grade by their late teens and can also be trained to lead a disciplined life by adhering to simple concepts like respect for others and ownership of property. Adult 21 years and above This person is capable of achieving social and vocational skills adequate for self-support under supervision for decision-making and handling finances.

John is hired by a social service agency to assist with the closing of cases which have been open for a long time. After discussing the situation with the executive director he understands that some cases have been open to services for 18 month or more with no real services being provided. The executive director suggests developing a bonus program which would pay a worker $50 for each month they kept their caseload under 35 open cases. This would reduce the number of cases which were open but did not need immediate services. John decides instead to offer a $50 bonus to each worker for every 8 cases they close which has been open for longer than 6 months. Relying on our behavioral background, which schedule of reinforcement is BEST described by John's plan? A) Fixed interval B) Fixed ratio C) Variable interval D) Variable ratio

The correct answer is B All of these schedules are called partial reinforcement, as opposed to continual reinforcement. In partial reinforcement, the response is reinforced only part of the time. The benefit to a partial reinforcement schedule is learned behaviors are acquired more slowly with partial reinforcement, but the response is more resistant to extinction. In this particular question the answer is a fixed ratio schedule. Fixed-ratio schedules are those where a response is reinforced only after a specified number of responses. This schedule produces a high, steady rate of responding with only a brief pause after the delivery of the reinforcer. A is INCORRECT Fixed-interval schedules are those where the first response is rewarded only after a specified amount of time has elapsed. This schedule causes high amounts of responding near the end of the interval, but much slower responding immediately after the delivery of the reinforcer. C is INCORRECT Variable-interval schedules occur when a response is rewarded after an unpredictable amount of time has passed. This schedule produces a slow, steady D is INCORRECT Variable-ratio schedules occur when a response is reinforced after an unpredictable number of responses. This schedule creates a high steady rate of responding. Gambling and lottery games are good examples of a reward based on a variable ratio schedule.

You have been working with a therapist who is involved in biofeedback and cognitive behavior therapy. They are using a form of thermal (heat) biofeedback to teach a client how to control his blood flow in order to reduce body temperature and reduce his migraine headaches. You know that biofeedback works with the nervous system and particularly with the _____________ Nervous system. A) Sympathetic. B) Parasympathetic. C) Somatic D) Endocrine.

The correct answer is B Biofeedback is used to reduce the stress response and increase the relaxation response that the parasympathetic nervous system controls. Biofeedback helps empower you to achieve better functioning through awareness and control. Biofeedback paired with relaxation and certain other therapy tools (desensitization, cognitive therapy, movement, body awareness, etc.) and/or bodywork is designed to reduce tension-fueling thought patterns and break habitual holding of tension, so that you can reduce your stress response and minimize stress-related bodily discomfort. Biofeedback is a method of measuring physiological functions you are not normally aware of (such as skin temperature, muscle tension, or brain waves) and then training yourself to control these functions. Depending on what particular physiological function you are working with, different techniques are used. The most common biofeedback techniques are: Temperature biofeedback EMG biofeedback EEG biofeedback Galvanic Skin Response With biofeedback you are in control. No needles and no medications. You learn to listen and talk to your body and make your nervous system an ally in your healing process. Learn how biofeedback works in this article. Biofeedback is enhanced with autogenic relaxation or visualization which are used to guide you into the desired state of relaxation, warmth, or muscle release. Skin Temperature Biofeedback Skin temperature biofeedback, also called Thermal Biofeedback, is the most common of all biofeedback techniques. Temperature biofeedback focuses on teaching you to alter your hand temperature. A thermistor is attached to one finger of your dominant hand. Changes in temperature as small as one tenth of a degree are registered and fed back to you through a digital display. Your job is to increase or decrease the temperature of your hand. Using thermal biofeedback relaxation to alter temperature of the body was one of the first biofeedback techniques to be used for healing. Researchers found that this particular method was useful in treating Raynaud's phenomena and migraine headaches. EMG Muscle Tension Biofeedback EMG biofeedback technique gives feedback about what is happening in a particular group of muscles, for example in the forehead or forearm. This feedback is usually both visual (digital display) and auditory (clicking sounds). With this feedback, you can learn to voluntarily relax or tense particular muscle groups. When muscles tighten, a series of electrical impulses travel to the muscle fibres. With decrease of electrical activity, relaxation of the muscles occurs. With EMG biofeedback, the electrical activity of the muscle is detected by the used of electrodes placed on the skin directly over the muscle that is being measured. The information is then fed back to you. Your goal is to decrease (or increase) this electrical activity, thus learning to control your muscle tension. EMG biofeedback was found to be particularly useful for tension headaches, anxiety, phobias, and insomnia. Electroencephalogram (EEG) Biofeedback EEG biofeedback, also called neurofeedback, is a learning strategy that allows you to alter your brain waves. As you watch your brainwave pattern on a monitor, you learn that you can change your brainwaves. Why would you want to change your brainwaves? Simple. There are 4 brainwave patterns (beta, alpha, theta, and delta), each associated with a different state. If you are looking for stress relief, then your goal is to learn to induce alpha brainwave patterns, associated with relaxation and calmness. In a typical EEG session, one or more electrodes are placed on your scalp, and one on each ear. Your brainwaves are monitored and displayed on a monitor. Through a computer game you learn how to change your brainwaves to a more desired frequency. EEG biofeedback is used for anxiety, depression, insomnia, chronic pain, addictions, chronic fatigue syndrome, and autoimmune disorders. Galvanic Skin Response (GSR) GSR reflects sweat gland activity and changes in the sympathetic nervous system. As you become anxious or stressed out, perspiration tends to increase, often in tiny amounts invisible to the eye. This moisture heightens the electrical conductance of a tiny electrical current between two points on the skin. A GSR biofeedback detects these changes and feeds them back to you through visual or auditory signal. This type of biofeedback has been found to be helpful in the treatment of phobias and hypertension. http://www.stress-relief-tools.com/biofeedback-techniques.html A IS INCORRECT sympathetic nervous system (SNS) is one of the three parts of the autonomic nervous system, along with the enteric and parasympathetic systems. Its general action is to mobilize the body's nervous system fight-or-flight response. It is, however, constantly active at a basic level to maintain homeostasis. http://en.wikipedia.org/wiki/Sympathetic_nervous_system C IS INCORRECT The somatic system is not part of your nervous system directly. Somatic means body and in the broadest sense, your entire physical structure is your somatic system. D IS INCORRECT The endocrine system is not part of the nervous system. It is a system of glands in the body and brain which produce hormones, the body's chief regulatory chemicals.

You have been asked by another social worker for help understanding some of the differences between schizophrenia and schizotypal personality disorder. Which of the four statements is NOT true? A) Both schizophrenics and schizotypals have difficulty on cognitive tasks. B) Both schizophrenics and schizotypals have enlarged ventricles. C) Both schizophrenics and schizotypals experience hallucinations and delusions. D) Both schizophrenics and schizotypals have odd or inappropriate emotional responses.

The correct answer is B According to Gaser, et. Al. in the American Journal of Psychiatry ... Ventricular enlargement in schizophrenia related to volume reduction of the thalamus, striatum, and superior temporal cortex. OBJECTIVE: Enlargement of the lateral ventricles is among the most frequently reported macroscopic brain structural changes in schizophrenia, although variable in extent and localization. The authors investigated whether ventricular enlargement is related to regionally specific volume loss. METHOD: High-resolution magnetic resonance imaging scans from 39 patients with schizophrenia were analyzed with deformation-based morphometry, a voxel-wise whole brain morphometric technique. RESULTS: Significant negative correlations with the ventricle-brain ratio were found for voxels in the left and right thalamus and posterior putamen and in the left superior temporal gyrus and insula. CONCLUSIONS: Thalamic shrinkage, especially of medial nuclei and the adjacent striatum and insular cortex, appear to be important contributors to ventricular enlargement in schizophrenia. Am J Psychiatry. 2004 Jan;161(1):154-6. Ventricular enlargement in schizophrenia related to volume reduction of the thalamus, striatum, and superior temporal cortex. Gaser C, Nenadic I, Buchsbaum BR, Hazlett EA, Buchsbaum MS. There is no indication of ventricle enlargement in Schizotypal Personality Disorder A IS INCORRECT Both of these are possible symptoms of both disorders C is INCORRECT Both of these are possible symptoms of both disorders D is INCORRECT Both of these are possible symptoms of both disorders EXTRA INFORMATION Symptoms of Schizophrenia Schizophrenia symptoms also can be attributed to other mental illnesses, and no one symptom can pinpoint a diagnosis of schizophrenia. In men, schizophrenia symptoms typically start in the teens or 20s. In women, schizophrenia symptoms typically begin in the 20s or early 30s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than 45. Signs and symptoms of schizophrenia generally are divided into three categories — positive, negative and cognitive. Positive symptoms In schizophrenia, positive symptoms reflect an excess or distortion of normal functions. These active, abnormal symptoms may include: · Delusions. These beliefs are not based in reality and usually involve misinterpretation of perception or experience. They are the most common of schizophrenic symptoms. · Hallucinations. These usually involve seeing or hearing things that don't exist, although hallucinations can be in any of the senses. Hearing voices is the most common hallucination among people with schizophrenia. · Thought disorder. Difficulty speaking and organizing thoughts may result in stopping speech midsentence or putting together meaningless words, sometimes known as word salad. · Disorganized behavior. This may show in a number of ways, ranging from childlike silliness to unpredictable agitation. Negative symptoms Negative symptoms refer to a diminishment or absence of characteristics of normal function. They may appear with or without positive symptoms. They include: · Loss of interest in everyday activities · Appearing to lack emotion · Reduced ability to plan or carry out activities · Neglect of personal hygiene · Social withdrawal · Loss of motivation Cognitive symptoms Cognitive symptoms involve problems with thought processes. These symptoms may be the most disabling in schizophrenia because they interfere with the ability to perform routine daily tasks. A person with schizophrenia may be born with these symptoms. They include: · Problems with making sense of information · Difficulty paying attention · Memory problems Symptoms in teenagers Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize in this age group. This may be in part because some of the early symptoms in teenagers are common during teen years, such as: · Withdrawal from friends and family · A drop in performance at school · Trouble sleeping · Irritability Compared with schizophrenia symptoms in adults, teens may be: · Less likely to have delusions · More likely to have visual hallucinations http://www.mayoclinic.com/health/schizophrenia/DS00196/DSECTION=symptoms Symptoms of Schizotypal Personality Disorder People with classic schizotypal personalities are apt to be loners. They feel extremely anxious in social situations, but they're likely to blame their social failings on others. They view themselves as alien or outcast, and this isolation causes pain as they avoid relationships and the outside world. People with schizotypal personalities may ramble oddly and endlessly during a conversation. They may dress in peculiar ways and have very strange ways of viewing the world around them. Often they believe in unusual ideas, such as the powers of ESP or a sixth sense. At times, they believe they can magically influence people's thoughts, actions and emotions. In adolescence, signs of a schizotypal personality may begin as an increased interest in solitary activities or a high level of social anxiety. The child may be an underperformer in school or appear socially out-of-step with peers, and as a result often becomes the subject of bullying or teasing. Schizotypal personality disorder symptoms include: · Incorrect interpretation of events, including feeling that external events have personal meaning · Peculiar thinking, beliefs or behavior · Belief in special powers, such as telepathy · Perceptual alterations, in some cases bodily illusions, including phantom pains or other distortions in the sense of touch · Idiosyncratic speech, such as loose or vague patterns of speaking or tendency to go off on tangents · Suspicious or paranoid ideas · Flat emotions or inappropriate emotional responses · Lack of close friends outside of the immediate family · Persistent and excessive social anxiety that doesn't abate with time Schizotypal personality disorder can easily be confused with schizophrenia, a severe mental illness in which affected people lose all contact with reality (psychosis). While people with schizotypal personalities may experience brief psychotic episodes with delusions or hallucinations, they are not as frequent or intense as in schizophrenia. Another key distinction between schizotypal personality disorder and schizophrenia is that people with the personality disorder usually can be made aware of the difference between their distorted ideas and reality. Those with schizophrenia generally can't be swayed from their delusions. Both disorders, along with schizoid personality disorder, belong to what's generally referred to as the schizophrenic spectrum. Schizotypal personality falls in the middle of the spectrum, with schizoid personality disorder on the milder end and schizophrenia on the more severe end.

According to Analytical and Psychoanalytical theories, the individual (EGO) protects themselves from damage while interfacing with reality (the REAL World) by using defense mechanisms. These defense mechanisms (ACTIONS taken) help control anxiety by deflecting and protecting the individual (EGO) from the demands of the id and superego. Which one of the following BEST describes a defense mechanism? A) Reaction formation. B) Dependence. C) Transitional awareness. D) Diffusion.

The correct answer is A In psychoanalytic theory, reaction formation is a defensive process (defense mechanism) in which anxiety-producing or unacceptable emotions and impulses are mastered by exaggeration (hypertrophy) of the directly opposing tendency. [as defined in Charles Rycroft, A Critical Dictionary of Psychoanalysis (London, 2nd Edn, 1995)] According to Calvin S. Hallin his work "A Primer of Freudian Psychology" (New York, 1954) ... the hypothesis of the creation of the reaction formation is..."instincts and their derivatives may be arranged as pairs of opposites: life versus death, construction versus destruction, action versus passivity, dominance versus submission, and so forth. When one of the instincts produces anxiety by exerting pressure on the ego either directly or by way of the superego, the ego may try to sidetrack the offending impulse by concentrating upon its opposite. For example, if feelings of hate towards another person make one anxious, the ego can facilitate the flow of love to conceal the hostility." Where reaction-formation takes place, it is usually assumed that the original, rejected impulse does not vanish, but persists, unconscious, in its original infantile form.[2] Thus, where love is experienced as a reaction formation against hate, we cannot say that love is substituted for hate, because the original aggressive feelings still exist underneath the affectionate exterior that merely masks the hate to hide it from awareness. According to Calvin Hallin, "reactive love protests too much; it is overdone, extravagant, showy, and affected. It is counterfeit, and [...] is usually easily detected. Another feature of a reaction formation is its compulsiveness. A person who is defending himself against anxiety cannot deviate from expressing the opposite of what he really feels. His love, for instance, is not flexible. It cannot adapt itself to changing circumstances as genuine emotions do; rather it must be constantly on display as if any failure to exhibit it would cause the contrary feeling to come to the surface. B IS INCORRECT According to MARY D. SALTER AINSWORTH of Johns Hopkins University in her work OBJECT RELATIONS, DEPENDENCY, AND ATTACHMENT: A THEORETICAL REVIEW OF THE INFANT-MOTHER RELATIONSHIP published in Child Development, 1969, 40, 969-1025... The concept of object relations stems from psychoanalytic instinct theory. The "object" of an instinct is the agent through which the instinctual aim is achieved, and the agent is usually conceived as being another person. It is generally agreed that the infant's first object is his mother. The origin of object relations lies in the first year of life, and most, although not all, psychoanalysts have viewed the infant's initial relationship with his mother as being essentially oral in nature. The major theoretical division, however, is between those who hold that there are at least prototypical object relations from the beginning and those who hold that "true" object relations grow out of and supplant the infant's earlier dependency relationship with his mother. Although the term dependency has been used by some psychoanalysts to characterize the infant's pre-objectal relations, it is especially linked to social learning theories. These theories follow the psychoanalytic lead in conceiving the origin of interpersonal relations to lie in the infant's dependence on his mother. (Although "dependency" and "dependence" may be used interchangeably, "dependency" has been preferred as a technical term in scientific and professional writing.) Dependency was defined at first as a learned drive, acquired through its association with the reduction of primary drives. Dependency could become a generalized personality trait, in regard to which there were individual differences, presumably reflecting different learning histories. Or, more recently, dependency has been viewed by learning theorists as a class of behaviors, learned in the context of the infant's dependency relationship with his mother, and reinforced in the course of her care of him and interaction with him. In any case, although the first dependecy relationship is a specific one-with the mother or mother substitute dependency is viewed as generalizing to other subsequent interpersonal relations and to be commonly nonspecific in its implications. Dependence connotes a state of helplessness. Behavior described as dependent implies seeking not only contact with and proximity to other persons but also help attention, and approval; what is sought and received is significant, not the person from whom it is sought or received. Dependency in the psychoanalytic context also has nonspecific implications, but object relations once acquired are considered sharply specific. Dependence implies immaturity, and, indeed, the term is the antonym of "independence." Although normal in the young child, dependence should gradually give way to a substantial degree of independence. And yet it may be observed that relationships to specific persons-whether termed "object relations," "attachments," or "dependency relationships"-develop concurrently with the development of the competencies upon which independence is based. Recognizing this paradox, some social learning theorists (e.g., Beller 1955; Heathers 1955) have disclaimed a bipolar dimension of dependence-independence, but this disclaimer leaves the term "dependency" a misleading one. Read more at ... http://www.psychology.sunysb.edu/attachment/online/attach_depend.pdf C is INCORRECT This is a meaningless term used as a RED HERRING D is INCORRECT A medical or chemical term not used in psychoanalysis

When systematic desensitization is used to treat a phobia, the feared object or event is considered to be A) the unconditioned stimulus. B) the unconditioned response C) the conditioned stimulus. D) the conditioned response

The correct answer is A The unconditioned stimulus is one that unconditionally, naturally, and automatically triggers a response. For example, when you smell one of your favorite foods, you may immediately feel very hungry. In this example, the smell of the food is the unconditioned stimulus. B is INCORRECT The unconditioned response is the unlearned response that occurs naturally in response to the unconditioned stimulus. In our example, the feeling of hunger in response to the smell of food is the unconditioned response. C is INCORRECT The conditioned stimulus is previously neutral stimulus that, after becoming associated with the unconditioned stimulus, eventually comes to trigger a conditioned response. In our earlier example, suppose that when you smelled your favorite food, you also heard the sound of a whistle. While the whistle is unrelated to the smell of the food, if the sound of the whistle was paired multiple times with the smell, the sound would eventually trigger the conditioned response. In this case, the sound of the whistle is the conditioned stimulus. D is INCORRECT The conditioned response is the learned response to the previously neutral stimulus. In our example, the conditioned response would be feeling hungry when you heard the sound of the whistle. These techniques are also useful in the treatment of phobias or anxiety problems. Teachers are able to apply classical conditioning in the class by creating a positive classroom environment to help students overcome anxiety or fear. Pairing an anxiety-provoking situation, such as performing in front of a group, with pleasant surroundings helps the student learn new associations. Instead of feeling anxious and tense in these situations, the child will learn to stay relaxed and calm.

You have been asked to consult on a case with another social worker. They are seeing a male client and they are concerned about the possibility of suicide. Given your knowledge of the risk factors which are associated with suicide, which of the following would cause you the MOST concern for suicide potential... A) the client is between the ages of 17 and 30 B) the client has expressed a desire to kill himself but has no plan C) the client has expressed a desire to kill himself, has a plan as well as goals for his future. D) the client has expressed a desire to kill himself, has a plan and has no goals for the future.

The correct answer is D In the current situation, the most threatening presentation is expressing a desire, having a plan and having no future goals. Future goals are considered protective factors which would lessen the risk assessment . There are many more factors to take into account and suicide assessment should only be completed by a licensed professional with training and competence. Some other issues involving suicide assessment include... The most common psychiatric symptoms associated with acute risk for suicidal behaviors include: agitation, anxiety, insomnia, acute substance abuse, affective dysregulation, profound depression, and psychosis. When reviewing a suicide plan, the factors to look for include ... 1) Details, 2) How prepared are they to complete the plan, 3) How soon do they intend to instigate the plan, 4) How do they intend to kill themselves (Lethality of method), and 5) What is the likelihood of intervention if they attempt the plan. The clearer the information you get on these questions, the more information you have to make a determination. Generally greater lethality, more plan details and a decreased likelihood of intervention will mean highly elevated risk. A IS INCORRECT While it is true the male in the age ranges of 17 to 30 has the highest risk of suicide, there are no discernable features in this answer that would allow you to quantify the risk. B IS INCORRECT This certainly should get your eyes open and elevate the level of risk, but it is not the greatest threat of the given answers. C IS INCORRECT This presents as a greater level of risk than answer B, but less risk than answer D, because future plans are a protective factor.

Incest and family dynamics have several commonalities. You are evaluating a family who has been referred for possible incest issues. After the evaluation, you have identified several interaction styles and familial roles, which cause you, concern. Which of the following family characteristics would be the BEST indicator incest occurring: A) serious enmeshment in family relationships with highly stylized roles. B) attitudes of permissiveness regarding sexuality. C) permeable boundaries and extreme chaos. D) Relationships that are high in conflict.

The correct answer is A Enmeshment had a tendency to develop poor boundaries between people. It fosters a "poor ego strength" which can result in blurring between roles and responsibilities. This "blurring" between roles can be very devastating to a family. According to Judith L. Herman in her 1981 book "Father-Daughter Incest." Published by Harvard University Press. She determined a number of 'markers' which would lead the therapist to believe there was a possibility of incest. Her study included 40 victims of father-daughter incest and 20 victims of non-contact sexual abuse. She discovered that "incestuous families were conventional to a fault. Most were churchgoing and financially stable. They maintained a facade of respectability that helped hide the sexual abuse. The fathers' authority in the families was absolute, often asserted by force. Half of the fathers were habitually violent, but never enough to send a family member to the hospital. Their sexual assaults were usually planned in advance. The men were feared within the family but impressed outsiders as sympathetic, even admirable. In the presence of superior authority, they were ingratiating, deferential, even meek. They were hard working, competent, and often very successful. Of the 40 fathers, 31 were the sole support of their families. Sex roles were rigidly defined. Mother and sisters were considered inferior to father and brothers. The incestuous fathers exercised minute control over the women's lives, often discouraging social contacts and keeping them secluded in the home. Most of the mothers were full-time housewives; six did some part-time work, and three had full-time jobs. B is INCORRECT Attitudes of permissiveness do not correlate highly with incest. C is INCORRECT Permeable boundaries and extreme chaos actually appear to correlate negative with incest. The incestuous family tends to be controlled, with rigid boundaries. Chaos seems to be the antithesis of incest. D is INCORRECT High conflict relationships tend to be negatively correlated with incest. This seems appropriate, as the severe violation, which occurs in incest, would require control and secrecy to maintain. A high conflict relationship would have a tendency to violate any secrecy and locus of control.

You have been working with parents who have an authoritative style of parenting. They encourage their children to be independent but still places controls and limits on their actions. You know that specific parenting styles will lead to specific outcomes. The BEST way to describe the children produced by the authoritative style is... A) dependent, passive, and submissive. B) disobedient, aggressive, and rebellious. C) independent, self-confident, and self-controlled. D) moody, creative, and independent.

The correct answer is C Authoritative parents will set clear standards for their children, monitor the limits that they set, and also allow children to develop autonomy. They also expect mature, independent, and age-appropriate behavior of children. Punishments for misbehavior are measured and consistent, not arbitrary or violent. Authoritative parents set limits and demand maturity, but when punishing a child, the parent will explain his or her motive for their punishment. They are attentive to their children's needs and concerns, and will typically forgive and teach instead of punishing if a child falls short. This is supposed to result in children having a higher self esteem and independence because of the give-take nature of the authoritative parenting style. This is the most recommended style of parenting by child-rearing experts A IS INCORRECT This is associated with the Authoritarian parenting style. The parent is demanding but not responsive. Authoritarian parenting, also called strict parenting, is characterized by high expectations of conformity and compliance to parental rules and directions, while allowing little open dialogue between parent and child. Authoritarian parenting is a restrictive, punitive parenting style in which parents make their children to follow their directions and to respect their work and effort. Authoritarian parents expect much of their child but generally do not explain the reasoning for the rules or boundaries. Authoritarian parents are less responsive to their children's needs, and are more likely to ground their child rather than discuss the problem. Authoritarian parenting deals with low parental responsiveness and high parental demand, the parents tend to demand obedience without explanation and focus on status. Children resulting from this type of parenting may have less social competence because the parent generally tells the child what to do instead of allowing the child to choose by him or herself B is INCORRECT The parent is responsive but not demanding. Indulgent parenting, also called permissive, nondirective or lenient, is characterized as having few behavioral expectations for the child. "Indulgent parenting is a style of parenting in which parents are very involved with their children but place few demands or controls on them." Parents are nurturing and accepting, and are very responsive to the child's needs and wishes. Indulgent parents do not require children to regulate themselves or behave appropriately. This may result in creating spoiled brats or "spoiled sweet" children depending on the behavior of the children. Children of permissive parents may tend to be more impulsive, and as adolescents, may engage more in misconduct, and in drug use. "Children never learn to control their own behavior and always expect to get their way." But in the better cases they are emotionally secure, independent and are willing to learn and accept defeat. They mature quickly and are able to live life without the help of someone else. D is INCORRECT These characteristics are not associated directly with any one parenting style.

We are moving into a more evidence-based world, and there is a movement to accept and provide therapy under practice theories which have evidence to validate their treatment approach. You have been asked the following question by your supervisor. Of the following practice theories, which one has the most empirical evidence to show it is successful? A) psychoanalytic B) social learning C) cognitive therapy D) gestalt

The correct answer is C Cognitive behavior therapy (CBT) is a type of psychotherapeutic treatment that helps patient's understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders, including phobias, addiction, depression and anxiety. Cognitive behavior therapy is generally short-term and focused on helping clients deal with a very specific problem. During the course of treatment, people learn how to identify and change destructive or disturbing thought patterns that have negative influences on behavior. Cognitive Behavior Therapy Basics The underlying concept behind CBT is that our thoughts and feelings play a fundamental role in our behavior. For example, a person who spends a lot of time thinking about plane crashes, runway accidents and other air disasters may find themselves avoiding air travel. The goal of cognitive behavior therapy is to teach patients that while they cannot control every aspect of the world around them, they can take control of how they interpret and deal with things in their environment. Cognitive behavior therapy has become increasingly popular in recent years with both mental health consumers and treatment professionals. Because CBT is usually a short-term treatment option, it is often more affordable than some other types of therapy. CBT is also empirically supported and has been shown to effectively help patients overcome a wide variety of maladaptive behaviors. Types of Cognitive Behavior Therapy According to the British Association of Behavioral and Cognitive Psychotherapies, "Cognitive and behavioral psychotherapies are a range of therapies based on concepts and principles derived from psychological models of human emotion and behavior. They include a wide range of treatment approaches for emotional disorders, along a continuum from structured individual psychotherapy to self help material." There are a number of different approaches to CBT that are regularly used by mental health professionals. These types include: · Rational Emotive Therapy · Cognitive Therapy · Multimodal Therapy http://psychology.about.com/od/psychotherapy/a/cbt.htm A is INCORRECT Due to the complexity and the process of psychoanalytic therapy, it is extremely difficult to design treatment studies which show any effect. Psychoanalytic therapy is one of the most well-known treatment modalities, but it is also one of the most misunderstood by mental health consumers. This type of therapy is based upon the theories and work of Sigmund Freud, who founded the school of psychology known as psychoanalysis. Psychoanalytic therapy looks at how the unconscious influences thoughts and behaviors. Psychoanalysis frequently involves looking at early childhood experiences in order to discover how these events might have shaped the individual and how they contribute to current actions. People undergoing psychoanalytic therapy often meet with their therapist at least once a week and may remain in therapy for a number of weeks, months or years. http://psychology.about.com/od/pindex/f/psychoanalytic-therapy.htm B is INCORRECT "Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do. Fortunately, most human behavior is learned observationally through modeling: from observing others one forms an idea of how new behaviors are performed, and on later occasions this coded information serves as a guide for action." -Albert Bandura, Social Learning Theory, 1977 What is Social Learning Theory? The social learning theory proposed by Albert Bandura has become perhaps the most influential theory of learning and development. While rooted in many of the basic concepts of traditional learning theory, Bandura believed that direct reinforcement could not account for all types of learning. His theory added a social element, arguing that people can learn new information and behaviors by watching other people. Known as observational learning (or modeling), this type of learning can be used to explain a wide variety of behaviors. Basic Social Learning Concepts There are three core concepts at the heart of social learning theory. First is the idea that people can learn through observation. Next is the idea that internal mental states are an essential part of this process. Finally, this theory recognizes that just because something has been learned, it does not mean that it will result in a change in behavior. http://psychology.about.com/od/developmentalpsychology/a/sociallearning.htm D is INCORRECT Like psychoanalytic therapy, due to the complexity and the process, it is extremely difficult to design treatment studies which show any effect. Gestalt psychology is a school of thought that looks at the human mind and behavior as a whole. Originating in the work of Max Wertheimer, Gestalt psychology formed partially as a response to the structuralism of Wilhelm Wundt. The development of this area of psychology was influenced by a number of thinkers, including Immanuel Kant, Ernst Mach and Johann Wolfgang von Goethe. "The fundamental "formula" of Gestalt theory might be expressed in this way," Max Wertheimer wrote. "There are 'wholes', the behavior of which is not determined by that of their individual elements, but where the part-processes are themselves determined by the intrinsic nature of the whole. It is the hope of Gestalt theory to determine the nature of such wholes" (1924). Major Gestalt Psychologists · Max Wertheimer · Kurt Koffka · Wolfgang Kohler · Gestalt Laws of Perceptual Organization Have you ever noticed how a series of flashing lights often appears to be moving, such as neon signs or strands of Christmas lights? According to Gestalt psychology, this apparent movement happens because our minds fill in missing information. This belief that the whole is greater than the sum of the individual parts led to the discovery of several different phenomena that occur during perception.

You have recently attended an in-service which talked about the psychologist, Margaret Mahler, you came away from it with the understanding that her concept of "individuation" results in ... A) achieving a unity among the psychological functions. B) the ability to establish relationships with others. C) incorporating the unconscious aspects of the personality into the conscious aspects. D) recognizing the individual existence of self and others.

The correct answer is D Clinical Implications of Separation-Individuation Theory in Brief Excerpted and adapted from M. Hossein Etezady, M.D., An intergenerational legacy: a discussion of Anni Bergman's paper, to be published in S. Akhtar, ed. Affect Development and Regulation During Separation-Individuation. In Press. Mahler's theory of separation-individuation has made an invaluable contribution to the understanding of the first three years of life (pre-oedipal period) and its effects on later development. Separation-individuation theory makes possible the elaboration of the intra-psychic and interpersonal course of events that result in the emergence of the separate individual. If we consider separation-individuation in all aspects of its clinical and developmental ramifications, we appreciate the wide scope of its implications, not only in clarifying mother-child interactions and object relations, but also in its intra-psychic dimensions. It provides illuminating clarity in explicating the realm of affective experience as a determining ingredient of psychic organization, structure formation, source of motivation and signaling function that can be traced as a developmental line throughout the sub-phases of separation-individuation. Separation-individuation theory views the intra-psychic from an inter-personal perspective while elaborating the inter-personal in intra-psychic terms. As such it deals with the inter-subjective approach to development and therapeutic process. It is couched in ego-psychological terms and accommodates our classical theories. It is compatible with and complementary to theories of attachment and self-psychology, and provides a conceptual scaffolding for developmental phenomena discovered or elaborated in cognitive or general psychology. Using separation-individuation as a frame of reference can be an invaluable asset in dealing with our more disturbed patients as well as the normal neurotic and highly-functioning individuals in analytic treatment. Understanding Separation-Individuation: While the physical separation from maternal corporal engulfment takes place at birth, the psychological separation is not possible before the infant has been able to establish sufficient capacity for autonomy, self-reflection and self-reliance. This developmental phase unfolds over the first two years of the infant's normal development -- first the infant's perceptions and coenesthenic perceptions are grouped, cross-referenced, and organized in preliminary patterns in response to mother's intuitive reactions. They coalesce to form a basic core and, in time, an affective core. The infant's global awareness is initially inner-directed and centered around proprioceptive sensations. Mother's perceptive reactions and finely-tuned and timed responses and her intuitive interpretation of the infant's internal states serve to establish an expanding dialogue. This strengthens her libidinal investment as her understanding of her infant nurtures their growing bond. As a consequence of the expansion of this dialogue, the cathexis of libidinal energies are drawn from the core to the periphery. The sense organs and the erotogenous zones of the body surface form a stimulating and searching source of gratification that depend on the libidinal availability of the mother. In the earliest phase of development, because the boundaries of the self and its mental representations have not yet been adequately elaborated, the infant perceives the mother as a part of his self-experience. There is an illusion of dual unity. Distinct boundaries between the internal and external, the self and the other, or the subject versus the object have not been established. Cognitive appreciation of events and states is not yet possible except in fragments of uni-modal perception which combine and coalesce only gradually and over a relatively long period of time. Mahler refers to this phase as the symbiotic phase which, at its peak, gives way to separation-individuation and its sub-phases. The symbiotic phase serves as a platform upon which the child's internal resources and capacities are assembled, coordinated, repeatedly tested and finely-tuned within a stable and secure orbit before the outer reaches of separation and autonomy can be sampled. It is within this symbiotic orbit that the infant establishes the foundation of confident expectation and the beginnings of his own individual resources that have evolved as byproducts of experiencing mastery. Throughout this period, it is the mother's libidinal availability and investment in her infant that gives life, sustenance and motivational impetus to the child's strides within this expanding universe. When mother's libidinal responsiveness and pleasure in being with the baby is amiss, enduring patterns of pathological development run roots and mar the basic core, distorting the subsequent development of the sense of optimism and confident expectation that constitute the foundations of narcissistic stability and cohesion. A IS INCORRECT Mahler's theory is very complex and rides on the back of the psychoanalysts. If words like 'symbiotic orbit', 'cathexis' and 'libidinal' are foreign to you, do not despair. Most social work schools have moved away from the psychoanalytic school in preference to brief therapy. I believe this is WRONG, and very short-sighted. Everything we do is based on the trail blazed by Freud, Jung, Adler, Erickson and many others. Don't let your lack of exposure keep you ignorant. This answer is minimally correct. At individuation there is a beginning of unity among the psychological functions, however, this development of unity will continue for years. Individuation is just the beginning. B is INCORRECT This is a process which occurs over your entire lifespan C is INCORRECT This is a process which occurs over your entire lifespan

During a monthly staff meeting, your supervisor asks every social work clinician to explain the difference between post-traumatic stress disorder and acute stress disorder as described in the DSM-IV TR. Your best response is A) The duration of the intrusive thoughts and flashbacks occur for more than one month and can be debilitating. B) the length of time between the trauma and the onset of the symptoms experienced by the client. C) The level of somatization, which can be observed in the responses to stressors or situations. D) the degree of trauma, including the nature of the trauma and any pathology that results from it.

The correct answer is A The primary diagnostic issues with PTSD are the identification of the trauma incident, the presence of intrusive thoughts and flashbacks, and the time frame of greater than 1 month of symptoms. B is INCORRECT There is no real value, from a clinical perspective, of knowing the length of time between the trauma and the onset of symptoms. Many of our ego defense mechanisms allow or create the suppression, denial or refusal of accepting what has occurred to us. These processes can skew the length of time between event and response. C is INCORRECT Somatization, the occurrence of tactile or physical symptoms, does not play a role in the diagnosis of PTSD or Acute Stress Disorder. D is INCORRECT The degree of trauma is individualized to each person. Some situations, which may cause you great trauma, may hardly impact someone else.

You are working with a counselor who is beginning a short-term group and they state they are not interested in their clients developing any insight into their actions. Which of the following types of therapy would BEST describe the overall concept of the group? A) psychoanalytical. B) behavioral C) Gestalt approaches. D) Adlerian

The correct answer is B Insight in behavior therapy Joseph R. Cautela Journal of Behavior Therapy and Experimental Psychiatry Volume 24, Issue 2, June 1993, Pages 155-159 Behavior therapists make frequent use of insight, but avoid the term because dynamic therapists have formulated it in terms of the unconscious. Insight does not necessarily imply belief in the existence of the "unconscious mind." Behavioral insight consists of making the client aware of the antecedents and consequences of target behavior. Case studies are presented in which behavioral insight was involved in therapeutic change. Implications of behavioral insight for behavior therapy are discussed. A is INCORRECT In psychoanalysis, insight is a process whereby one grasps a previously misunderstood aspect of one's own mental dynamics. It refers to a specific moment, observable during the treatment, when the patient becomes aware of an inner conflict, an instinctual impulse, a defense, or the like, that was previously repressed or disavowed and that, when it emerges into consciousness, elicits surprise and a sense of discovery. Two forms of the experience have been described. The first involves a feeling of sudden discovery or illumination kind of "Eureka!" moment. The second is a slower, more gradual process where the subject and usually the analyst as well experience a sensation of the obvious: "Yes, that's how it is. We knew this, of course, but now it's perfectly clear." In all cases, something other than simple intellectual comprehension is involved. Frequently, understanding at a lower level, laden with cultural references and general, abstract concepts constructed as defenses, is replaced by deeper insight that leads patients to question their entire personal histories and thinking. This happens, for example, when patients, after making defensive comments about oedipal conflicts, relive and reabsorb their own oedipal dramas. In such cases the economic and dynamic charge of such a shift and the accompanying emotions run far deeper than mere intellectual understanding http://www.enotes.com/insight-reference/insight C is INCORRECT Gestalt therapy makes use of focused awareness in addition to experimentation to reach the goal and develop insight. The way the patient becomes aware is decisive to every phenomenological investigation. It is not just personal awareness the phenomenologist studies but the process of awareness itself as well. The patient should understand how to be aware of awareness. The way the therapist and the client experience their relationship is of particular importance (Yontef, 1976, 1982, 1983). http://www.gestalttheory.com/concepts/ D is INCORRECT A lifestyle analysis helps the Adlerian therapist gain insights into client problems by determining the clients' basic mistakes and assets. These insights are based on assessing family constellation, dreams, and social interest. In order to assist the client to change, Adlerian therapists may use a number of active techniques that focus to a great extent on changing beliefs and reorienting the client's view of situations and relationships.

To a psychoanalyst who follows the work of Sigmund Freud, understanding the initial event which leads to obsessive-compulsive behavior is the result of fixation at a specific stage of psychosexual development. The specific stage is BEST labeled is... A) oral B) genital C) phallic D) anal

The correct answer is D In the early 1910s, Sigmund Freud attributed obsessive-compulsive behavior to unconscious conflicts that manifest as symptoms. Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions. Symptoms of the disorder include excessive washing or cleaning; repeated checking; extreme hoarding; preoccupation with sexual, violent or religious thoughts; aversion to particular numbers; and nervous rituals, such as opening and closing a door a certain number of times before entering or leaving a room. These symptoms can be alienating and time-consuming, and often cause severe emotional and financial distress. The acts of those who have OCD may appear paranoid and potentially psychotic. However, OCD sufferers generally recognize their obsessions and compulsions as irrational, and may become further distressed by this realization. http://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder A is INCORRECT (ORAL) Psychologically, Sigmund Freud (1856-1939) proposed that if the nursing child's appetite were thwarted during any libidinal development stage, the anxiety would persist into adulthood as a neurosis (functional mental disorder). Therefore, an infantile oral fixation (oral craving) would be manifest as an obsession with oral stimulation; yet, if weaned either too early or too late, the infant might fail in resolving the emotional conflicts of the oral, first stage of psychosexual development and he or she might develop a maladaptive oral fixation. The infant who is neglected (insufficiently fed) or who is over-protected (over-fed) in the course of being nursed, might become an orally-fixated person. Said oral-stage fixation might have two effects: (i) the neglected child might become a psychologically dependent adult continually seeking the oral stimulation denied in infancy, thereby becoming a manipulative person in fulfilling his or her needs, rather than maturing to independence; (ii) the over-protected child might resist maturation and return to dependence upon others in fulfilling his or her needs. Theoretically, oral-stage fixations are manifested as garrulousness, smoking, continual oral stimulus (eating, chewing objects), and alcoholism. Psychologically, the symptoms include a sarcastic, oral sadistic personality, nail biting, oral sexual practices. http://en.wikipedia.org/wiki/Oral_stage B is INCORRECT In the genital stage, as the child's energy once again focuses on his genitals, interest turns to heterosexual relationships. The less energy the child has left invested in unresolved psychosexual developments, the greater his capacity will be to develop normal relationships with the opposite sex. If, however, he remains fixated, particularly on the phallic stage, his development will be troubled as he struggles with further repression and defenses. C is INCORRECT The phallic stage is the setting for the greatest, most crucial sexual conflict in Freud's model of development. In this stage, the child's erogenous zone is the genital region. As the child becomes more interested in his genitals, and in the genitals of others, conflict arises. The conflict, labeled the Oedipus complex (The Electra complex in women), involves the child's unconscious desire to possess the opposite-sexed parent and to eliminate the same-sexed one. In the young male, the Oedipus conflict stems from his natural love for his mother, a love which becomes sexual as his libidal energy transfers from the anal region to his genitals. Unfortunately for the boy, his father stands in the way of this love. The boy therefore feels aggression and envy towards this rival, his father, and also feels fear that the father will strike back at him. As the boy has noticed that women, his mother in particular, have no penises, he is struck by a great fear that his father will remove his penis, too. The anxiety is aggravated by the threats and discipline he incurs when caught masturbating by his parents. This castration anxiety outstrips his desire for his mother, so he represses the desire. Moreover, although the boy sees that though he cannot posses his mother, because his father does, he can posses her vicariously by identifying with his father and becoming as much like him as possible: this identification indoctrinates the boy into his appropriate sexual role in life. A lasting trace of the Oedipal conflict is the superego, the voice of the father within the boy. By thus resolving his incestuous conundrum, the boy passes into the latency period, a period of libidal dormancy. On the Electra complex, Freud was more vague. The complex has its roots in the little girl's discovery that she, along with her mother and all other women, lack the penis which her father and other men posses. Her love for her father then becomes both erotic and envious, as she yearns for a penis of her own. She comes to blame her mother for her perceived castration, and is struck by penis envy, the apparent counterpart to the boy's castration anxiety. The resolution of the Electra complex is far less clear-cut than the resolution of the Oedipus complex is in males; Freud stated that the resolution comes much later and is never truly complete. Just as the boy learned his sexual role by identifying with his father, so the girl learns her role by identifying with her mother in an attempt to posses her father vicariously. At the eventual resolution of the conflict, the girl passes into the latency period, though Freud implies that she always remains slightly fixated at the phallic stage. Fixation at the phallic stage develops a phallic character, who is reckless, resolute, self-assured, and narcissistic--excessively vain and proud. The failure to resolve the conflict can also cause a person to be afraid or incapable of close love; Freud also postulated that fixation could be a root cause of homosexuality.

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