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Comprehensive Exam Prep


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What are the 3 best predictors of violent behavior?
1. Hx of violent acts with arrest or criminal activity.

2. Excessive alcohol intake.

3. Hx of childhood abuse.
Crisis interventions are characterized by what four components?
1. Here-and-now orientation.

2. Time-limited course (typically 1-6 sessions)

3. View of the client's behavior as an understandable rather than a pathological reaction to stress.

4. Therapist's assumption of an active, directive role.
(Crisis interventions)
Directive approaches include those that address (4 areas):
1. Affect (helping client express feelings generated by the crisis)

2. Cognitions (helping the client eliminate negative beliefs that contributed to the crisis)

3. Behaviors (requiring the client to spend more time with other people)

4. Environment (e.g., referring the client to an agency that can help alleviate financial concerns).
Suicide Assessment (comprehensive version)
Integrates information from a variety of sources including:
clinical hx
mental status exam
ongoing clinical evaluations
client's physician
significant others
assessment instruments
Suicide (direct assessment)
(5 items)
1. Communicated intent?
2. Have a plan?
3. Is it specific?
4. Have the means?
5. Plan+Means = lethal?
Suicide Intervention (least to most directive)
1. Refer for psychiatric & med eval

2. "No suicide contract," daily phone check-in, increased # of weekly sessions, 24-hour watch by family member or reliable friend, voluntary hospitalization, and involuntary hospitalization.
Domestic Violence (victim safety plan)
1. Help victim recognize warning signs of approaching danger.
2. Devise a foolproof escape route:
(how to exit, what she'll need -house keys, car keys, money, change of clothes, medications, phone list of resources, where she can go, taking the kids).

3. Rehearse the plan at least 2xs.
(Potential) Behavioral indicators of physically abusive parents
1. Does not tell the same story as the child about how the injury happened.
2. May say the child seems to have a lot of accidents.
3. Severely punishes the child.
4. Cannot control anger and frustration.
5. Expects too much from the child.
6. Talks about having problems dealing with the child.
7. Talks about the child as being bad, different or "the cause of my problems."
8. Does not show love towards the child.
9. Does not go to the doctor right away to have injury checked.
10. Has little or no help caring for the child.
Tarasoff criteria
Tarasoff (therapist duty)
1. Assess seriousness of the threat.
2. Attempt to get the client to not acting on it.
3. Discharge legally mandated duty to warn as req by law if threat is serious.
4. Adjust the tx plan accordingly.
Anger Management strategies
1. Teach appropriate expression of feelings, wants and needs.

2. Teach anger management skills (e.g., time-out, counting to 10).

3. Assign journaling to keep track of angry feelings.

4. Assign physical activities for constructive release of anger (tennis,bowling,weights,mountain hiking,mountain biking) - a physical activity that requires concentration.
Factors influencing the choice of unit of tx.
1. Abused children
2. Spouses w/ domestic violence
3. Marital problems
4. Children w/behavioral problems
1. Abused child (don't include the perpetrator in session)
2. Spouses d.v. (don't treat together)
3. Marital problems (treat couple together)
4. Child behavioral prob. (treat the family)
Methods to assess impact of family hx on family relationships (if you are oriented toward a family system model)?
Use the clues in the vignette to connect family of orgin issues to the presenting issue(s). A genogram is a good example of an assessment.
Research show what two issues to be related to family hx?
Child abuse and spousal abuse.
Native American
(What is the best tx choice?)
Systemic approach w/emphasis on relationships.
Give concrete, practical advice.
(What is the best tx choice?)
Family therapy. This culture tends to attribute their emotional problems to family conflicts and financial difficulties.
(A therapeutic focus upon individual over family needs is likely to run counter to cultural preferences)
How will your theory address the presenting problem (after the crisis)?
1. Identify and correct the client's distorted negative cognitions and teach client to do the same.

2. Clarify and challenge the client's underlying cognitive schemata.

3. Increase the client's adaptive problem-solving repertoire.
How will your theory address the presenting problem (after the crisis)?
1. Raise self-esteem.
2. Improve communication.
3. Access and actualize potential for growth.
4. Identify family roles and how they promote symptoms.
How will your theory address the presenting problem (after the crisis)?
1. Reduce level of anxiety and alleviate the symptoms.
2. Raise the client's level of self-differentation.
How will your theory address the presenting problem (after the crisis)?
1. Decrease unproductive conflict between individuals, including disputes about who is responsible for the problem.
2. Pave the way for individuals to cooperate with each other, to unite in a struggle against the problem, and to escape its influences on their lives and relationships.
3. Open new possibilities for individuals to take action so that they can reclaim their lives and relationships from the problem and its influences.
How will your theory address the presenting problem (after the crisis)?
1. Alleviate pathological symptoms.
2. Make the unconscious conscious.
3. Reintegrate previously repressed material into the total personality structure.
4. Provide a corrective emotional experience.
How will your theory address the presenting problem (after the crisis)?
1. Restructure the family's system of boundaries.
2. Establish appropriate boundaries.
3. Create an effective hierarchial structure.
How do you formulate a tx plan?
The goals need to follow those goals typically associated w/the theoretical model you use.
(e.g., CB model you could talk about the client's all-or-nothing thinking that increased their inability to manage the stress associated w/the psychosocial stressor,
Systems model-you could talk about the "systems reaction" to the psychosocial stressor and how this impacted each family member's ability to function)
What do you do with the client after the crisis is stabilized?
Develop a tx plan, that focuses on the framework you will use, to address the issues within the client or within the system that will improve their ability to function when experiencing future crises.

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