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Chapter 16 Practice Exam Questions

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 16: Psychological Treatment LEARNING GOALS 1. Be able to explain standards for studies on psychotherapy and the gaps in the generalizability of treatment outcome research. 2. Be able to discuss issues with adapting psychotherapies for people from diverse ethnic and cultural backgrounds. 3. Be able to identify the specific types of psychological treatments that have empirical support, and issues that clinicians must consider in applying these treatments. 4. Be able to describe different approaches to integrating psychotherapies and identifying common elements across treatments. 5. Be able to discuss the goals of community psychology and political trends in that field. Summary Challenges in Evaluating Treatment Outcomes ● Research on the effectiveness of various forms of psychological treatments has been conducted for many decades. Overall, this research suggests that about 75 percent of people gain some improvement from therapy. Therapy also seems to be more helpful than a placebo or the passage of time. ● Efforts have been made to define standards of research on psychotherapy trials and to summarize the current state of knowledge on which psychological treatments work. These standards typically include the need to randomly assign participants to treatment or a control, to use a treatment manual, to define the treated sample carefully, and to use reliable and valid outcome measures. It is hoped that these efforts will help disseminate the best available therapeutic practices to clinicians and their clients, as well as provide insurance companies with the data to support the use of psychotherapy. ● Controversy exists about the research standards.Alarge portion of clients are excluded or will not take part in clinical trials, cultural diversity is lacking in most trials, many treatment approaches remain untested, and treatment manuals can constrain a talented therapist. Abroader concern is that a huge gap exists between what happens in the research world and the real world. Efficacy research focuses on how well therapies work in carefully controlled experiments, whereas effectiveness research focuses on how well therapies work in the real world. The Importance of Culture and Ethnicity in Psychological Treatment ● Clinicians offering treatment to minority individuals must be sensitive to the values and political events that shape the way people may approach relationships, therapy, and emotional expression. Little empirical research is available on how psychotherapies work for people from diverse backgrounds, but minority status is associated with less use of therapy. Researchers have developed modifications of some treatments to be more culturally sensitive. Specific TreatmentApproaches: Issues and Treatment Outcome Research ● Experiential psychotherapies, based on humanistic and existential psychology, emphasize the freedom to choose, personal growth, and personal responsibility . Variants of these approaches include Rogers’client-centered therapy, existential therapy, Gestalt therapy, and emotion-focused therapy. ● Treatment outcome research supports the efficacy of psychodynamic, experiential, and cognitive behavioral approaches compared to no treatment or treatment controls. Behavioral approaches offer a clear advantage for the treatment of anxiety and may be slightly more helpful than experiential approaches in other disorders. Generally, the literature on how these different active forms of psychotherapy compare to each other is quite limited. ● Cognitive behavioral treatments have evolved over the past 10 years, and several manuals incorporate broader themes such as spirituality and meaning.Although there is less research available, the research findings about cognitive behavioral treatments are promising. ● Marital or couples therapy helps distressed couples resolve the inevitable conflicts in any ongoing relationship of two adults living together. Behavioral therapies are clearly better than no treatment, but within a matter of a couple years, at least half of couples return to significant distress. Promising evidence exists for integrative behavioral marital therapy and insight-oriented marital therapy as compared to standard behavioral marital therapy. ● Family therapy includes many different techniques. These therapies have been shown to be particularly successful in the treatment of externalizing disorders in children and adolescents, in helping people with substance abuse accept the need for treatment, and in reducing relapse in adults with schizophrenia and bipolar disorder. Psychotherapy Integration ● There are three different approaches to therapy integration: technical eclecticism, theoretical integration, and common factorism. Technical eclecticismrefers to borrowing techniques from other approaches while maintaining a focused conceptual approach. Theoretical integration is exemplified by Wachtel’s cyclical psychodynamics, or by the recent inclusion of a focus on acceptance within cognitive behavioral therapies. Common factors research identifies variables that predict outcomes across a broad range of therapies, such as the quality of the therapeutic alliance or therapist empathy. Community Psychology ● Community psychology aims primarily at the prevention of disorder on a large-scale. Political issues have shaped the popularity of this approach. 1. Which of the following statements are true? a. Generally speaking, psychotherapy is effective. b. Less than 25% of people who enter psychotherapy treatment improve. c. Psychotherapy is more effective with women and children than with men. d. Outcome research is designed specifically to find the best treatment forAxis II disorders. Answer:AType: Factual Page: 530 2. Research shows that people who enter psychotherapy show improvement a. most of the time. b. about half the time. c. most of the time if their problems are minor. d. equal to the support of good friends. Answer:AType: Factual Page: 530 3. Ano-treatment control group allows researchers to test which of the following? a. whether random assignment is effective. b. whether the data is valid. c. whether the passage of time helps a person recover as much as the active treatment does. d. whether the data is reliable. Answer: C Type: Factual Page: 530 4. Most treatments on theAPAtask force list of empirically supported treatments are a. rational-emotive. b. cognitive-behavioral. c. interpersonal. d. psychodynamic. Answer: C Type: Factual Page: 531 5. By current standards, in order to receive grant funding for treatment outcome research in psychotherapy, a researcher must a. have a therapy manual. b. have access to licensed therapists. c. be affiliated with a medical school. d. be familiar with psychopharmacological agents. Answer:AType: Factual Page: 532 6. Manuals in psychotherapy outcome research provide greater internal validity meaning that a. the within-study results are more reliable. b. researchers can more confidently attribute results to the specific treatment offered. c. researchers can confidently generalize results to psychotherapy practiced outside of the controlled study. d. researchers can specify the exact mechanism of change. Answer: B Type: Factual Page: 532 7. Therapy conducted using a manual has ______ internal validity and_____ external validity. a. high; high b. high; low c. low; high d. low; low Answer: B Type: Factual Page: 532 8. Therapy manuals are used to ensure that therapists use a. procedures tailored to the individual. b. optimal procedures in therapy. c. the same procedures in research. d. procedures validated by research. Answer: C Type: Factual Page: 532 9. Theoretically, the use of manuals a. does little to account for differences in therapists. b. controls for different levels of therapist skill. c. is only appropriate during a randomized clinical trial. d. None of the above are correct. Answer: B Type: Factual Page: 532 10. The purpose of treatment manuals is to a. clearly define the independent variable. b. allow for greater external validity. c. limit the amount that therapists vary in how they deliver the treatment. d. Both a and c are correct. Answer: D Type: Factual Page: 532 11.Aproblem with the use of treatment manuals is a. the client may feel that his or her particular concerns are not being addressed. b. they do not provide good internal validity. c. they are often convoluted and difficult to follow. d. they are only useful for psychodynamic research. Answer:AType: Factual Page: 532 12. Tom feels that he meets criteria for social phobia. He learned of these symptoms from ads for a free trial of therapy. He decides he would like to participate in the study. Tom might be excluded from participating in the study if he a. is depressed because of his social phobia . b. smokes cigarettes. c. also has post-traumatic stress disorder. d. has a relative with social phobia. Answer: C Type:Applied Page: 533 13. When a researcher determines that the outcome of a randomized controlled treatment study on schizophrenia is associated with reduction in negative symptoms, he or she is referring to the________ of the treatment. a. effectiveness b. efficacy c. positive effects d. grant-funded nature Answer: B Type:Applied Page: 533 14. When considering the outcome of therapy trials, who is in the best position to determine effectiveness? a. the client b. the therapist c. the grant-funding agency d. the research assistants Answer:AType: Factual Page: 533 15. The advent of managed care has changed what aspect of practice for psychologists? a. theoretical orientation b. focus on underlying causes c. accountability d. efficacy Answer: C Type:Applied Page: 534: Focus on Discovery 16.1 16. Yoshi is receiving therapy for social phobia. As part of therapy, he is instructed to imitate a series of target behaviors demonstrated by his therapist. Yoshi will be best able to model these behaviors if a. the therapist is of the opposite sex. b. his symptoms are mild. c. the therapist has cultural competence d. All of above are correct. Answer: C Type:Applied Page: 535 17. Cultural competence refers to whether therapists a. are effective within their own culture. b. understand the culture of their clients. c. are certified in the study of cultures. d. come from a similar culture to their clients. Answer: B Type: Factual Page: 535 18. Which of the following factors may be more important in contributing to good outcomes in therapy than ethnic matching? a. agreement on theoretical orientation between therapist and client b. same age bracket for therapist and client c. same gender for therapist and client d. cultural competence Answer: D Type: Factual Page: 535 19. African American patients a. are less satisfied with ethnically-similar therapists. b. have likely experienced prejudice. c. will inevitably run into insurmountable barriers in therapy. d. All of the above are correct. Answer: B Type: Factual Page: 536 20. The text urges white therapists working with Latino clients to be especially sensitive to which of the following cultural issues? a. personal and family losses. b. importance of religion. c. anger at majority culture. d. respect for authority. Answer: B Type: Factual Page: 536 21. Which of the following is a characteristic ofAsianAmericans? a. They tend to talk about stress in psychical terms. b. They do not experience discrimination like other ethnic minorities. c. They are individualistic people. d. All of the above are correct. Answer:AType: Factual Page: 536 22. Unlike other cultural groups, Asian Americans may a. feel more shame regarding the necessity of therapy. b. feel that some areas are 'off-limits' in therapy. c. identify a need for greater formalities in treatment. d. All of the above are correct. Answer: D Type: Factual Page: 536 23. Tim is a NativeAmerican child in therapy forADHD. He frequently avoids eye contact with his therapist. This is likely a sign of a. low self-esteem. b. shame about therapy. c. respect. d. guilt. Answer: C Type:Applied Page: 537 24. Empirically supported treatments for specific minority groups a. have not been effective. b. are overwhelmingly psychodynamic. c. rarely include a control group. d. are few and far between. Answer: D Type: Factual Page: 538 25. According to Duran (2004), culturally sensitive interventions may need to be modified to change a. the role of the therapist. b. the types of intervention strategies used. c. the content of the intervention and how to present aspects of the content. d. All of the above are correct. Answer: D Type: Factual Page: 538 26. The major goal of psychoanalytic approaches to therapy involves a. removal of repressions. b. the interplay of behavioral events and internal attributions. c. identifying associations between unconscious motivations and superego functioning. d. determining accurately the operative defense mechanisms. Answer:AType:Applied Page: 539 27. Psychoanalysis primarily focuses on a. presenting symptoms. b. unconscious conflicts from earlier in life. c. cognitive biases associated with neuroticism. d. None of the above are correct. Answer: B Type: Factual Page: 539 28. If two different people were in therapy, one seeing a traditional psychoanalyst and one seeing a more contemporary psychodynamic therapist, you would a. be able to decipher who saw which kind of therapist from their descriptions of the clinicians. b. have difficulty deciphering who saw which kind of therapist from their descriptions of the clinicians. c. see a greater focus on childhood from the contemporary psychodynamic therapist. d. find the traditional psychoanalyst to be more emotionally invested than the contemporary psychodynamic therapist. Answer: B Type:Applied Page: 539 29. Amajor problem of outcome research in psychoanalytic therapy is a. methodological flaws. b. the large number of studies makes it difficult to determine for whom therapy is best suited. c. the low education level of most of the study participants. d. All of the above are problems in outcome research on psychoanalytic therapy. Answer:AType:Applied Page: 540 30. One problem with studying outcomes of brief psychodynamic treatments is a. evaluating transference effects. b. comparing them to lengthier approaches. c. the lack of agreed treatment manuals. d. which approaches to include. Answer: D Type: Factual Page: 540 31. Sara is in psychoanalytic therapy. She will do best in treatment if a. she is well educated. b. she has schizophrenia. c. she is middle-aged. d. All of the above factors will be associated with better outcome. Answer:AType:Applied Page: 540 32. Client-centered therapy suggests a. problems arise from inner disturbance associated with ego-conflicts. b. disorders are a result of failing to attend to one's own experiences.. c. psychological problems arise from interpersonal difficulties exclusively. d. cognitive errors create neurotic disturbance. Answer: B Type: Factual Page: 541 33. Sandra is a graduate student in clinical psychology. As part of her training, she is encouraged to develop good listening skills and unconditional positive regard, exhibit empathy and genuineness, and hold clients in a positive light. These are all central features of which therapeutic paradigm? a. psychodynamic b. cognitive c. behavioral d. client-centered Answer: D Type:Applied Page: 541 34. Lucy is currently a patient and a subject in a psychotherapy outcome study being run by a Rogerian therapist. Lucy is most likely to a. complete self-report questionnaires about herself, have her family interviewed, and have a medical exam. b. be self-actualized. c. have her functioning rated by her family and friends only. d. suffer from severe psychopathology. Answer: B Type:Applied Page: 541 35. Which of the following therapies emphasize the notion that each of us are ultimately alone in the world and that we must create our own existence? a. existential b. client-centered c. Gestalt d. psychoanalytic Answer:AType: Factual Page: 541 36. In which of the following ways are gestalt therapy and client-centered therapy similar? a. Both emphasize inner conflict as the root cause of psychological disturbance. b. Each encourage structured behavioral exercises to alleviate inner distress. c. Both focus on an innate goodness in the client. d. None of the above are correct. Answer: C Type:Applied Page: 541-542 37. In Gestalt therapy, a “here and now” focus refers to a focus on a. events in the session. b. the therapeutic alliance. c. the client’s current life. d. reactance. Answer:AType: Factual Page: 542 38. Alison is in therapy with a Gestalt therapist.As part of therapy, she is asked to imagine that her mother is in the room, and she is instructed to communicate to her how she feels, while gazing at a seat in the room. This is also known as the a. empty-chair technique. b. enacted interaction method. c. analogue interaction. d. accurate empathy. Answer:AType:Applied Page: 543: Focus on
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