Treating Those with Mental Disorders A Comprehensive Approach to Case Conceptualization and Treatmen

Instructor’s Resource Manual and Test Bank For

Treating Those with Mental Disorders: A Comprehensive Approach to Case Conceptualization and Treatment 2nd Edition

Table of Contents Course Syllabus

1

Chapter Discussion Questions and Activities

9

Chapter 1: Developing Effective Treatment Plans

9

Chapter 2: Real World Treatment Planning: Systems, Culture, and Ethics

9

Chapter 3: Safety-Related Clinical Issues and Treatment Planning

10

Chapter 4: Depressive, Bipolar, and Related Disorders

11

Chapter 5: Anxiety Disorders

11

Chapter 6: Obsessive-Compulsive and Related Disorders

12

Chapter 7: Trauma- and Stressor-Related Disorders

13

Chapter 8: Substance-Related and Addictive Disorders

14

Chapter 9: Personality Disorders

15

Chapter 10: Schizophrenia Spectrum and Other Psychotic Disorders

16

Chapter 11: Feeding and Eating Disorders

16

Chapter 12: Disruptive, Impulse-Control, Conduct, and Elimination Disorders

17

Chapter 13: Neurodevelopmental and Neurocognitive Disorders

18

Chapter 14: Dissociative Disorders and Somatic Symptom and Related Disorders

19

Chapter 15: Sleep-Wake Disorders, Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria

20

Additional Case Studies

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Chapter 4 Case Study: Chad

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Chapter 5 Case Study: Joseph

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Chapter 6 Case Study: Cindy

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Chapter 7 Case Study: Janet

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Chapter 8 Case Study: Michelle

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Chapter 9 Case Study: Courtney

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Chapter 10 Case Study: Elena

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Chapter 11 Case Study: Denine

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Chapter 12 Case Study: Sachin

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Chapter 13 Case Study: Tonya

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Chapter 14 Case Study: Maria

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Chapter 15 Case Study: Juan

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Test Bank Questions

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Answer Key

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Treating Those with Mental Disorders Course Syllabus Created by Jessica Headley, PhD, LPC (Ohio) Instructor Name / Rank:

Office Hours:

Office Phone:

E-Mail:

Office: Class Meeting – Time/Place:

Catalog Description: This course focuses on counseling theories of abnormal behavior and mental disorders throughout the lifespan. Specific evidence-based treatments for each mental health disorder will be examined, with a particular emphasis on developmental, strength-based, and culturally sensitive clinical practices.

Prerequisite: XXXXX

Required Text: Kress, V. E, & Paylo, M. J. (2018). Treating those with mental disorders: A comprehensive approach to case conceptualization and treatment (2nd ed.). Columbus, OH: Pearson.

Required Readings: XXXXXX

Requisite Knowledge, Skills, and Dispositional Bases: In order to accurately conceptualize, diagnose, and treat mental disorders, students must develop knowledge, skills, and competencies that are informed by current standards and guidelines set forth by the profession.

Students must thoroughly understand the characteristics associated with various mental disorders, the etiology of these disorders, and the application of empirically derived treatment methods. Throughout the course, students will be expected to engage in reflective practice and adopt a critical lens to better understand the influence of the historical and sociopolitical context as it relates to client conceptualization, diagnosis, and treatment, so as to develop the necessary knowledge, skills, and competencies.

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Course Learning Objectives: Adhering to the designated 2016 CACREP Clinical Mental Health Counseling (CMHC) Standards, this course will provide an introduction to the following standards: Student Learning Outcomes

CACREP Standards

Assessment

CMHC 1.b

Treatment Paper Article Presentation Treatment Plan Assignment “5 Things” Announcement Case Presentation Final Paper

Principles, models, and documentation format of biopsychosocial case conceptualization and treatment planning

CMHC 1.c

Treatment Paper Article Presentation Treatment Plan Assignment “5 Things” Announcement Case Presentation Final Paper

Neurobiological and medical foundation and etiology of addiction and co-occurring disorders

CMHC 1.d

Treatment Paper Article Presentation “5 Things” Announcement

Psychological tests and assessments specific to clinical mental health counseling

CMHC 1.e

Treatment Paper Article Presentation Treatment Plan Assignment “5 Things” Announcement Case Presentation

CMHC 2.a

Treatment Paper Article Presentation Treatment Plan Assignment Advocacy Presentation “5 Things” Announcement Case Presentation Final Paper Treatment Paper Article Presentation Treatment Plan Assignment Advocacy Presentation “5 Things” Announcement Case Presentation Final Paper

Foundations Theories and models related to clinical mental health counseling

Contextual Dimensions Roles and settings of clinical mental health counselors

Etiology, nomenclature, treatment, referral, and prevention of mental and emotional disorders

CMHC 2.b

Mental health service delivery modalities within the continuum of care, such as inpatient, outpatient, partial treatment and aftercare, and the mental health counseling service networks

CMHC 2.c

Article Presentation Treatment Plan Assignment “5 Things” Announcement Case Presentation Final Paper

Diagnostic process, including differential diagnosis and the use of current diagnostic classification systems, including the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD)

CMHC 2.d

Article Presentation Treatment Plan Assignment “5 Things” Announcement Case Presentation Final Paper

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Potential for substance use disorders to mimic and/or cooccur with a variety of neurological, medical, and psychological disorders

CMHC 2.e

Article Presentation Treatment Plan Assignment “5 Things” Announcement Case Presentation Final Paper

Impact of crisis and trauma on individuals with mental health diagnoses

CMHC 2.f

Treatment Paper Treatment Plan Assignment “5 Things” Announcement Case Presentation Final Paper

Impact of biological and neurological mechanisms on mental health

CMHC 2.g

Treatment Paper Treatment Plan Assignment “5 Things” Announcement Case Presentation Final Paper

Classifications, indications, and contraindications of commonly prescribed psychopharmacological medications for appropriate referral and consultation

CMHC 2.h

Treatment Plan Assignment “5 Things” Announcement Case Presentation Final Paper

Legislation and government policy relevant to clinical mental health counseling

CMHC 2.i

Treatment Paper Advocacy Presentation “5 Things” Announcement

Cultural factors relevant to clinical mental health counseling

CMHC. 2.j

Treatment Paper Article Presentation Treatment Plan Assignment Advocacy Presentation “5 Things” Announcement Case Presentation Final Paper

CMHC 3.a

Treatment Paper Clinical Interview Treatment Plan Assignment “5 Things” Announcement Case Presentation Final Paper

Techniques and interventions for prevention and treatment of a broad range of mental health issues

CMHC 3.b

Creative Intervention Clinical Interview Treatment Plan Assignment Final Paper Advocacy Presentation “5 Things” Announcement Case Presentation

Strategies for interfacing with the legal system regarding court-referred clients

CMHC 3.c

Clinical Interview Advocacy Presentation “5 Things” Announcement

Strategies for interfacing with integrated behavioral health care professionals

CMHC 3.d

Clinical Interview Advocacy Presentation “5 Things” Announcement

Practice Intake interview, mental status evaluation, biopsychosocial history, mental health history, and psychological assessment for treatment planning and caseload management

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CMHC 3.e

Strategies to advocate for persons with mental health issues

Clinical Interview Advocacy Presentation “5 Things” Announcement

Instructional Methods: To address the varied learning needs of students, this course will involve diverse instructional methods. Lectures will be used to enhance understanding of course content and will include the use of technology (e.g., PowerPoint presentations and applicable video clips). Additionally, students will be expected to engage in interactive classroom discussions, role-plays, and small group work (e.g., case vignettes, projects, and discussion). Internet resources will be utilized to facilitate student learning and classroom discussions. Readings from the text and professional journal articles will also be required throughout the course.

Possible Course Requirements: Teaching and learning are considered to be dynamic and reciprocal processes that require the active participation of the instructor and the student. Students are thus expected to read the assignments, pose critical questions, and make thoughtful comments. In addition, students are encouraged to apply the theoretical constructs and ideas to their clinical cases by bringing in case material that relates to their experiences when appropriate. Instructional strategies in this course are aimed at facilitating this process. ●

Students are expected to read course assignments prior to class and demonstrate their active engagement with the material by participating in class discussions (e.g., providing reflective comments and asking questions).

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Students will view videos/clips in class that demonstrate various treatment interventions. Case vignettes and small group interactions addressing complex issues will be used to enhance knowledge, skills, and competencies related to case conceptualization, diagnosis, and treatment.

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Students will complete a midterm and a final exam to demonstrate their ability to apply course material to multifaceted case vignettes and multiple-choice questions.

Possible Assignments 1. Construct a Creative Intervention ●

Construct your own creative activity (based in an evidence-based approach) to address a treatment goal for a specific population that you would like to eventually work with in the future. This activity should be approximately 1.5-2 pages in length and should utilize the following headers: Activity Name, Activity Overview, Treatment Goal Addressed, Directions, and Process Questions. Each chapter within the text has two examples of these creative activities. Please consult these for structure and style considerations.

2. My View of Clients and Treatment Paper ●

Write a 4-5 page paper that addresses the following questions: o When do clients’ problems begin? Who/what is responsible for those problems? Where do those problems come from?

▪ As part of your response, (a) identify and briefly describe counseling theories that align with your view and (b) briefly discuss how genetics, biological, and environmental factors contribute to mental illness. o How should clients’ problems be treated? What is your ideal treatment plan/approach to clients? What is your role in the prevention of mental illness?

▪ As part of your response, briefly discuss (a) the role of psychological tests and assessments in treatment and (b) current evidence on strategies for prevention.

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o

o

3.

How do you view clients’ role in their treatment? How do you view your role in the treatment of your clients? How do you view the role of others (e.g., family members, friends, and community) when approaching treatment?

▪ As part of your response, briefly discuss the importance of biopsychosocial case conceptualization and treatment planning.

How do cultural factors, legislation and government policy, and the impact of crisis and trauma impact case conceptualization and/or treatment?

▪ As part of your response, briefly discuss current research and trends related to these considerations.

Article Presentation (group project) ●

For your assigned disorder category, provide a 30-minute group presentation on an article which addresses an empirically supported treatment (e.g., an article discussing DBT for Borderline Personality Disorder). The presentation will be due on the day that the topic is scheduled to be discussed in class.

Print an outline of the article and provide any resources related to the application of the treatment discussed in the article.

Presentation must include some type of classroom activity that involves peers (e.g., if the treatment involves mindfulness, conduct a mindfulness exercise with the class).

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4.

Treatment Plan Assignment ● ●

5.

Part I: Develop a case vignette (like the ones at the start of each chapter). Please make sure the case vignette presents a DSM diagnosis with all criteria being outlined in the narrative. This section should be around 2 pages in length.

Part II: Construct a Treatment Plan using the I-CAN-START model (like the ones at the end of each chapter). Please make sure the treatment plan outlines an evidence-based approach to treating that mental health diagnosis and provides sufficient SMART goals (for a review, see Chapter 1). Be sure to address the “I” aspect of the model.

Weekly Reaction Card ● ●

6.

Each student will turn in a weekly reaction card following the assigned reading. On each card, the student will provide a score for the following question: On a scale from 1-100%, how comfortable do I feel working on issues covered within this chapter with a future client?

In addition, the student will provide a rationale for their score to address growing edges (e.g., reducing bias and gaining knowledge on topic) and their strengths (e.g., personal experience and extensive knowledge on topic).

Clinical Interview with a Licensed Professional ●

Invite a counselor at a local agency to participate in a 30 minute in-person or phone interview. Please use the interview protocol provided below to guide the interview. Interviewee responses should be typed below each question. o

Can you please provide an overview of the services your agency provides?

o

What is your role within the agency (e.g., title and duties)?

o

What are the most prevalent diagnoses that you treat?

o

How do you use diagnosis in your work?

o

How important do you view diagnosis?

o

What is an ethical dilemma you have faced that relates to diagnosis and/or treatment?

And, how did you address the dilemma?

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7.

What strategies do you utilize to determine a diagnosis and subsequent treatment?

o

In what ways do you use advocacy and/or a strengths-based approach throughout the treatment process?

o

In what ways do you collaborate with other behavioral health care professionals throughout the treatment process?

o

In what ways do you collaborate with the legal system when working with court-referred clients?

o

How do you stay abreast of professional issues related to diagnosis and treatment?

o

What is one piece of advice that you would give me regarding case conceptualization, diagnosis, and treatment?

“5 Things You Can Do” (to learn more) Announcement ●

Each student will be assigned to provide an announcement for a chapter. The announcement will serve as a student resource tool related to the assigned topic. The announcement will be accompanied by a one-page handout and will include: o o o o o

8.

o

One publication that can be utilized to assist in treatment planning One online resource that can be utilized to gain more information on the topic A workshop or training to gain increased knowledge, skills, and competencies Information on an advocacy effort on the community level related to this topic Information on an advocacy effort on the national level related to this topic

Use of Assessment Data: Case Presentation (group project; pairs) ●

Each group will be assigned one chapter from the text and the group will select one disorder from the chapter.

One student will be the counselor, and the other student will be the client. Students will engage in a 30-minute (live or video-recorded) mock session that will feature core characteristics of the selected diagnosis and the utility of an intake assessment and the mental status examination. Following the roleplay, the students will facilitate a discussion that addresses the following categories: o o o o o o o

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Identifying information (e.g., age, gender, and race/ethnicity) Chief complaint Symptoms Client history (e.g., substance use, childhood, education, employment, spirituality/religion, current stressors, coping, support, and strengths) Mental status examination Diagnosis Treatment recommendations

Advocacy Presentation (group project) ●

Students will identify an advocacy effort related to treatment and diagnosis for one specific population (e.g., veterans, older adults, sexual minorities) and present a 30- minute group presentation that addresses the following: o o o o o

Introduction and background of the issue (e.g., history, key terms) Why this is a problem What is being done about it What is recommended to create change Summary and conclusions 6

10. Final Paper & Presentation (group project) A. Your group will be assigned a disorder category below and choose 1 movie listed: ▪ Neurodevelopmental Disorders (Rain Main, I am Sam, What’s Eating Gilbert Grape?, Forrest Gump) ▪ Bipolar Disorders (Mr. Jones, The Hours) ▪ Depressive Disorders (Prozac Nation) ▪ Obsessive-Compulsive and Related Disorders (What About Bob?, As Good as it Gets) ▪ Disorders of Behavior and Impulse Control (Lady Sings the Blues, Leaving Las Vegas) ▪ Personality Disorders (The Aviator, Fatal Attraction) ▪ Schizophrenia Spectrum and Other Psychotic Disorders (A Beautiful Mind) ▪ Dissociative Disorders (Me, Myself, & Irene; Sybil) B. Group Paper Contents: o Develop a case history of the client including the following information: (you may infer to some degree to clarify your view of this client) ▪ Demographic information (e.g., sex, age, ethnic background, physical characteristics, disability) ▪ Developmental milestones ▪ Social context(s) in which she/he grew up ▪ Significant events in infancy, childhood, adolescence, adulthood ▪ What he/she was like as a child, adolescent, adult ▪ Relationships with parents and any siblings, past and present ▪ Peer relationships, past and present ▪ Significant others/partners ▪ Sexuality ▪ Favorite memories/most unpleasant memories ▪ Educational history ▪ Spirituality ▪ Vocational history ▪ Family history re: health, including mental health ▪ Date of onset of each symptom ▪ How she/he describes herself/himself ▪ Mental status type information ▪ Presenting complaint ▪ Hobbies, priorities, habits, how he/she spends his/her time ▪ Anything else that you think is important to know in order to understand one's frame of reference o Develop a Treatment Plan (using the I CAN START format presented in the text) o Provide information of empirically supported treatment(s) for the disorder category (minimum of 3 research articles to support this section) o Discuss challenges/difficulties in working with such a client specifically (from the movie) and a client in general diagnosed with such a disorder (e.g., things to avoid, things to be mindful of, and common misconceptions) C. Group Project Summary: Provide the instructor with your group’s chosen movie, a brief summary of the identified character to be diagnosed, and a complete diagnosis.

Day of Presentation: Provide a PowerPoint presentation (no more than 2 pages of slides) presenting your client to the class (basically presenting the parts of your paper). Provide a hand-out to the class and instructor that contains a Reference Page containing at least 5 resources for working with a client with that particular disorder (Example: Client is diagnosed with Major Depressive Disorder. Your group may provide a resource on treating this disorder). Provide video clips to enhance your presentation.

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COURSE SCHEDULE **Course content/schedule is subject to change due to class participants and/ or situations surrounding it** Date

Topic

Readings

Week 1

Introduction Developing Effective Treatment Plans Real World Treatment Planning: Systems, Culture, and Ethics

Ch. 1 Ch. 2

Week 2 Week 3 Week 4 Week 5 Week 6

Safety-Related Clinical Issues and Treatment Planning Depressive, Bipolar, and Related Disorders Anxiety Disorders

Ch. 3

Obsessive-Compulsive and Related Disorders Trauma- and Stressor-Related Disorders

Ch. 6

Ch. 5

Ch. 7 Midterm Exam

Substance-Related and Addictive Disorders Personality Disorders

Ch. 8

Schizophrenia Spectrum and Other Psychotic Disorders Feeding and Eating Disorders Disruptive, Impulse-Control, and Conduct, and Elimination Disorders

Ch. 10

Week 13

Neurodevelopmental and Neurocognitive Disorders

Ch. 13

Week 14

Dissociative Disorders and Somatic Symptom and Related Disorders

Ch. 14

Week 15

Sleep Wake Disorders, Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria

Ch. 15

Week 9 Week 10 Week 11 Week 12

Activities

Ch. 4

Week 7 Week 8

Assignments Due

Ch. 9

Ch. 11 Ch. 12

Week 16

Final Exam

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Chapter Discussion Questions and Activities Chapter 1: Developing Effective Treatment Plans Discussion Questions and Activities 1.

List some of the potential factors that influence the outcomes of counseling treatment. Be sure to list at least three counselor variables, three client variables, and three treatment variables that directly impact counseling outcomes.

2.

Briefly outline the five stages of the clients’ readiness for change model. Additionally, explain how counselors may aid and impact clients at each of these stages to promote clients’ progress.

3.

Brainstorm some ways that you will attempt to strengthen and foster a positive therapeutic alliance.

Specifically, what skills, attributes, and attitudes are essential in building a strong therapeutic relationship? What might get in your way?

4.

Discuss what “good” treatment planning looks like in clinical practice. Highlight a few of the facets of “effective” treatment planning.

5.

Using Figure 1.2, construct a four-sentence statement that captures your own character strengths and resiliencies. Share your strengths statements with another classmate. If you have difficulties with this activity, try to start each statement with “I am …”

6.

Utilizing Figure 1.1, 1.2, 1.3, and 1.4, construct a set of structured interview questions that can aid a counselor in addressing clients’ (a) strengths, capacities, and resources and (b) adheres to a clients’ cultural context. Share your set of questions with another classmate.

7.

Discuss the I CAN START model of treatment planning. How will this model aid you in case conceptualization and treatment planning? List the strengths and limitations of this model in clinical practice. What other considerations might you add to the model to further enhance it?

8.

Discuss the importance of the “I” in the I CAN START treatment planning process? Why do you think the “I” is first in the model? Talk about your “I” (i.e., who are you as a counselor/counselor trainee and how will that impact your counseling and treatment planning.

Chapter 2: Real World Treatment Planning: Systems, Culture, and Ethics Discussion Questions and Activities 1.

Review the section on managed care systems. Using the Internet, find and review information on the Mental Health Parity Act. When was it signed into law? What are key aspects of this legislation?

2.

Imagine that you are in clinical practice and your supervisor requests that you upcode, or give a more restrictive diagnosis, to a client you are working with to ensure delivery of services. The suggested diagnosis does not accurately describe the client’s presenting issue. What do you do?

3.

What qualities and characteristics are necessary for a counselor working on a treatment team with other professionals (e.g., psychiatrist, primary care provider)? Practice introducing yourself as a professional counselor to a mock treatment team with a partner.

4.

Identify three limitations of the DSM. How do these limitation impact clinical practice?

5.

Review the section on ethics. Using the Internet, find and review the current American Counseling Association’s Code of Ethics. What are the core professional values of the counseling profession? What six main purposes does the Code of Ethics serve?

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6.

Review the case study of Anika (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reaction to Manuel including his lived experiences, his problems/ difficulties, and his actions/behaviors ● Describe his (C) contextual assessment ● Describe his (A) assessment and diagnosis ● Describe his (N) necessary level of care ● Describe his (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Anika that may be useful Compare and contrast your responses with the I CAN START model treatment plan application at the end of the chapter.

Chapter 3: Safety-Related Clinical Issues and Treatment Planning Discussion Questions and Activities 7.

Review the section on suicidal clients. What fears and worries do you have concerning work with a client who is suicidal? Describe some of the considerations and interventions that need to be utilized with a client who is suicidal.

8.

Using table 3.1 and 3.2, write a case vignette of a suicidal client. Share this narrative with a classmate.

Discuss how you might work with this client and what would be your short-term and long-term treatment goals for the client.

9.

Using Figure 3.7 (pp. 79-80), engage in role-play with a classmate as if one of you was a client experiencing homicidal ideation and the other was a professional counselor. Discuss how it felt to be in your role with your partner.

10. Review the section on interpersonal partner violence victims. What fears and worries do you have about working with this population? Describe some considerations and interventions that need to be utilized with this population.

11. Review the case study of Toni (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reaction to Manuel including his lived experiences, his problems/ difficulties, and his actions/behaviors ● Describe his (C) contextual assessment ● Describe his (A) assessment and diagnosis ● Describe his (N) necessary level of care ● Describe his (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Toni that may be useful Compare and contrast your responses with the I CAN START model treatment plan application at the end of the chapter.

12. Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific safety-related clinical issue (i.e., suicide, homicide, interpersonal partner violence). In constructing this activity, adhere to the following format: (a) general overview; (b) treatment goals of the creative activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions. Use the two creative toolbox activities within the chapter as a guide.

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Chapter 4: Depressive, Bipolar, and Related Disorders Discussion Questions and Activities 13. Consider a time when you felt down or depressed over the course of your lifespan. Reflect on how long you felt like this: were there any precipitating events?; how intense were your feelings/emotions?; what kinds of thoughts did you have during this time?; did you have sleep and/or appetite changes?; how was your level of energy and motivation during this time?; how did you interact and relate to others?; and, what aided and helped you in improving your mood? Considering these reflections, ponder how this may aid you in working with someone who is feeling down or depressed.

14. Compare and contrast the four evidence-based approaches (i.e., cognitive-behavioral therapy, mindfulness-based cognitive therapy, behavioral activation therapy, and interpersonal psychotherapy) for treating those with major depressive disorder. Be sure to pay attention to the similarities and differences of each of these approaches.

15. Review the seven categories of antidepressants (p. 105). Use the Internet (e.g., FDA, WebMD, Mayo Clinic) to compile a list of the potential side effects associated with each of these categories of antidepressants.

16. Review the section on disruptive mood dysregulation disorder (DMDD). Discuss the differential diagnosis with intermittent explosive disorder, oppositional defiant disorder, attentiondeficit/hyperactivity disorder, and autistic spectrum disorder. Additionally, what are some of the basic tenets that will need to be considered in the treatment of those with DMDD? 17. Review the case study of Manuel (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reaction to Manuel including his lived experiences, his problems/ difficulties, and his actions/behaviors ● Describe his (C) contextual assessment ● Describe his (A) assessment and diagnosis ● Describe his (N) necessary level of care ● Describe his (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Manuel that may be useful Compare and contrast your responses with the I CAN START model treatment plan application at the end of the chapter.

18. Construct a creative toolbox activity based on a treatment approach outlined in the chapter. Tailor the activity to a specific clinical population. In constructing this activity, adhere to the following format: (a) general activity overview; (b) treatment goals of the creative activity; (c) provide directions on how to implement the activity in clinical practice; and (d) process questions. Use the two creative toolbox activities within the chapter as a guide.

19. Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

Chapter 5: Anxiety Disorders Discussion Questions and Activities 1.

Consider a time in your life when you felt exceptionally anxious. Reflect on how long you felt like this: were there any precipitating events?; how intense were your feelings/emotions?; what kinds of thoughts

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did you have during this time?; did you have sleep and/or appetite changes?; how did you interact and relate to others?; and, what aided or helped you in feeling better? Using these reflections, ponder how this may aid you in working with someone who is feeling anxious.

2.

Reflect on some of the fears you have had over the course of your life. How do/did they impact your thoughts, feelings, and behaviors? Did they impact your level of functioning? Discuss the similarities and differences between fears and phobias.

3.

Discuss when and how you may utilize exposure therapy (in vivo) in clinical practice. Construct a stepby-step approach to using this treatment with a specific situation.

4.

Compare and contrast the three outlined approaches (i.e., cognitive-behavioral therapy [Borkovec’s cognitive avoidance model], cognitive-behavioral therapy- [intolerance of uncertainty model], and acceptance and commitment therapy) for treating those who have generalized anxiety disorder. Be sure to pay attention to the similarities and differences of each of these approaches.

5.

Review the case study of Ka-Sean (at the beginning of the chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reactions to Ka-Sean including her lived experiences, her problems/ difficulties, and her actions/behaviors ● Describe her (C) contextual assessment ● Describe her (A) assessment and diagnosis ● Describe her (N) necessary level of care ● Describe her (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Ka-Sean Compare and contrast your answers with the I CAN START model application at the end of the chapter.

6.

Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions.

Use the two creative toolbox activities within the chapter as a guide.

7.

Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

Chapter 6: Obsessive-Compulsive and Related Disorders Discussion Questions and Activities 1.

Show clips of the film, As Good as It Gets featuring Jack Nicolson and Helen Hunt. These clips can be located on an internet search. After watching it, explore how his (Jack Nicolson’s character) compulsive behaviors are depicted in the film; how his disorder affected his life and level of functioning; his interpersonal interactions with others; and how he is able to cope in everyday life.

2.

Discuss the differences between superstitions and compulsions. How might these two things look similar and/or different in clinical practice? How might culture impact these experiences?

3.

Describe some of the counselor considerations for working with people with body dysmorphic disorder. Which one of these considerations would be most difficult for you to deal with as a counselor?

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4.

Compare and contrast the treatments for those with trichotillomania or excoriation (skin-picking) disorder. Discuss and outline the basic tenets of one of those approaches.

5.

Review the case study of John (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reaction to John including his lived experiences, his problems/ difficulties, and his actions/behaviors ● Describe his (C) contextual assessment ● Describe his (A) assessment and diagnosis ● Describe his (N) necessary level of care ● Describe his (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for John Compare and contrast your answers with the I CAN START model write-up at the end of the chapter.

6.

Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions.

Use the two creative toolbox activities within the chapter as a guide.

7.

Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

Chapter 7: Trauma- and Stressor-Related Disorders Discussion Questions and Activities 1.

List some of the counselor considerations for working with people with acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). As a counselor, which ones of these considerations would be the most difficult for you to manage?

2.

Define and discuss the concept of vicarious trauma. How (and in what ways) might this impact you in your clinical work with people who have trauma and stress-related disorders? What are some things you can do to protect yourself from the effects of vicarious trauma?

3.

Review the section on prolonged exposure therapy (PET; p. 222). Outline the basic tenets of this approach and discuss how this approach might be implemented in clinical practice.

4.

Conduct a literature review and select one article in a peer-reviewed journal describing the implementation of each of these approaches: (a) eye movement desensitization reprocessing (EMDR), and (b) trauma-focused cognitive behavioral therapy (TF-CBT). After reading both articles, compare and contrast these approaches in the treatment of those with trauma and stress-related disorders.

5.

Review the case study of Imani (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reactions to Imani including her lived experiences, her problems/ difficulties, and her actions/behaviors ● Describe her (C) contextual assessment ● Describe her (A) assessment and diagnosis ● Describe her (N) necessary level of care ● Describe her (S) strengths, capacities, and resources (at the individual, family, and community levels)

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●

List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Imani Compare and contrast your answers with the I CAN START model write-up at the end of the chapter.

6.

Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions.

Use the two creative toolbox activities within the chapter as a guide.

7.

Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

Chapter 8: Substance-Related and Addictive Disorders Discussion Questions and Activities 1.

Using an internet search, locate movie clips of the movies Requiem for a Dream, Basketball Diaries, or Trainspotting. After watching one of these films – or clips- describe how addiction is depicted in that film; how this disorder affects the individual(s) life and level of functioning; the individual(s) interpersonal interactions with others; at what lengths that individual(s) goes for continued use of the substance; and your perception of addiction and the relationship some individuals have with substances.

2.

Review the section on Motivational Interviewing (MI). Describe the basic tenants of MI and list five ways/examples it could be utilized in clinical practice. How can it be used in counseling part from just substance use?

3.

Compare and contrast the treatment models for those with alcohol-related disorders. Highlight similarities and differences in each of the approaches.

4.

Review the section of drug-related disorders. Select one of the categories of substance disorders (e.g., cannabis, hallucinogen, opioid) and explore that category more comprehensively. Utilizing this structure: (a) the most common drugs within this category; (b) effects of these drugs (e.g., pros and cons); (c) the cycle of use and accessibility issues; (d) tolerance and withdrawal issues associated with this category of drugs; and (e) treatment modalities and approaches.

5.

Review the case study of Dianna (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reactions to Dianna including her lived experiences, her problems/ difficulties, and her actions/behaviors ● Describe her (C) contextual assessment ● Describe her (A) assessment and diagnosis ● Describe her (N) necessary level of care ● Describe her (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Dianna Compare and contrast your answers with the I CAN START model write-up at the end of the chapter.

6.

Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative

14

activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions.

Use the two creative toolbox activities within the chapter as a guide.

7.

Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

Chapter 9: Personality Disorders Discussion Questions and Activities 1.

Review table 9.1 (Overview of Key Personality Disorders; p. 270). Discuss what specific personality disorders would be the most difficult for you to work with in clinical practice. What aspects of your own personality would make those interactions more difficult? What are some considerations you could implement to be more effective with that specific population in the future?

2.

Select one of the treatment approaches mentioned in the entire personality disorder chapter (e.g., schema therapy, dialectical behavioral therapy, psychodynamic, cognitive behavioral therapy) and conduct additional research (i.e., do a literature review of peer-reviewed journal articles) on that approach with a specific personality disorder.

3.

Review the section on dialectical behavior therapy (DBT). Discuss the basic tenets of the approach including the four corresponding modules: (a) mindfulness, (b) distress tolerance, (c) emotional regulation, and (d) interpersonal effectiveness skills. What other mental health disorders might this approach be useful with in clinical practice?

4.

Utilizing table 9.2 (Cognitive Treatment Aims for Those with Personally Disorders; p. 293-294), comprise a list of TV or movie characters that reflect the basic beliefs, assumptions, and behaviors of each of the personality disorders. Share this list with a classmate.

5.

Review the case study of Jane (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reactions to Jane including her lived experiences, her problems/ difficulties, and her actions/behaviors ● Describe her (C) contextual assessment ● Describe her (A) assessment and diagnosis ● Describe her (N) necessary level of care ● Describe her (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Jane Compare and contrast your answers with the I CAN START model write-up at the end of the chapter.

6.

Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions.

Use the two creative toolbox activities within the chapter as a guide.

7.

Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

15

Chapter 10: Schizophrenia Spectrum and Other Psychotic Disorders Discussion Questions and Activities 1.

Rent the film A Beautiful Mind featuring Russell Crowe, or select clips from the internet. After watching it, describe how the main character’s psychotic symptoms are: depicted in the film; how his disorder affected his life and level of functioning; his interpersonal interactions with others; and how he copes and survives in everyday life.

2.

List all of the myths and misconceptions that people have about those with schizophrenia spectrum and other psychotic disorders (e.g., schizophrenia, schizoaffective, delusional disorder). Be sure to include what you have seen in the media (e.g., movies, TV shows), books, magazines, and in other news outlets. How do these myths and misconceptions affect the public perception of those with these disorders? What professional responsibilities do counselors have to advocate for this population? What are a few things that counselors can do to address these concerns?

3.

Review Walsh’s (2011) five recommendations for communicating with someone who is experiencing psychosis. Translate those five recommendations into five specific examples (e.g., transcripts, narrative, example statements). Share these examples with another classmate.

4.

Discuss the treatment approaches for people with schizoaffective disorder. Be sure to integrate the psychotherapy and psychopharmacotherapy options to address both psychosis and mood symptoms.

5.

Review the case study of Mitchell (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reaction to Mitchell including his lived experiences, his problems/ difficulties, and his actions/ behaviors ● Describe his (C) contextual assessment ● Describe his (A) assessment and diagnosis ● Describe his (N) necessary level of care ● Describe his (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Mitchell Compare and contrast your answers with the I CAN START model write-up at the end of the chapter.

6.

Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions.

Use the two creative toolbox activities within the chapter as a guide.

7.

Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

Chapter 11: Feeding and Eating Disorders Discussion Questions and Activities 1.

Discuss our society’s attitudes towards body weight, body image, and the concept of “beauty.” What impact do these ideals have on people’s sense of self and their perception of the ideal body image and body weight? How do the societal expectations around beauty differ for females and males, and how is this manifested in terms of psychopathology?

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2.

Compare and contrast the essential characteristics, medical complications, counselor considerations, and treatment approaches for those with anorexia nervosa verse those with bulimia nervosa.

3.

Eating disorders consume people’s thoughts. To increase your empathy for those with eating disorders, keep a food diary for a whole week. Document the following items every time you eat: exactly what you eat; the quantity; when you eat it; where you eat it; if it satisfied your hunger; what else you wanted to eat; whether or not you thought about food more or less often than normal; and how eating made you feel. Additionally, document your weight every time you eat. After the week is over, reflect on how this new level of awareness may increase your empathy for those suffering with eating disorders.

4.

Discuss the three treatment approaches (cognitive behavioral therapy, interpersonal psychotherapy, dialectical behavior therapy) for working with those with binge eating disorder. Be sure to highlight the strengths and limitations of each approach.

5.

Review the case study of Alicia (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reactions to Alicia including her lived experiences, her problems/ difficulties, and her actions/ behaviors ● Describe her (C) contextual assessment ● Describe her (A) assessment and diagnosis ● Describe her (N) necessary level of care ● Describe her (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Alicia Compare and contrast your answers with the I CAN START model application at the end of the chapter.

6.

Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions.

Use the two creative toolbox activities within the chapter as a guide.

7.

Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

Chapter 12: Disruptive, Impulse-Control, Conduct, and Elimination Disorders Discussion Questions and Activities 1.

Males are more likely than females to be diagnosed with oppositional defiant disorder, conduct disorder, and/or intermittent explosive disorder. Why do you think this happens in our society? What can be done to prevent these disorders from developing, and how can they be identified early?

2.

Compare and contrast the essential characteristics, counselor considerations, and treatment approaches for those with conduct disorder verse those with intermittent explosive disorder.

3.

Discuss the treatment approaches (i.e., multisystemic therapy, family therapy, parent management training, behavior therapy, cognitive behavioral therapy, problem-solving skill training, school-based interventions) for working with those with oppositional defiant disorder/conduct disorder. Be sure to highlight the strengths and limitations of each approach. Which approach for this population makes the most sense to you and why?

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4.

Discuss the similarities and differences in the characteristics, considerations, and treatment approaches for those with enuresis verse those with encopresis.

5.

Review the case study of Andrew (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reaction to Andrew including his lived experiences, his problems/ difficulties, and his actions/ behaviors ● Describe his (C) contextual assessment ● Describe his (A) assessment and diagnosis ● Describe his (N) necessary level of care ● Describe his (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Andrew Compare and contrast your answers with the I CAN START model application at the end of the chapter.

6.

Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions.

Use the two creative toolbox activities within the chapter as a guide.

7.

Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions

Chapter 13: Neurodevelopmental and Neurocognitive Disorders Discussion Questions and Activities 1.

Individuals on the autistic spectrum eventually grow up and transition into adulthood. What are some of the changes they face as adults in terms of their relationships, careers, and personal development and adjustment?

2.

Describe the use of cognitive behavioral therapy to treat those with attention-deficit/hyperactivity disorder. Outline the facets of this approach and provide a few general examples of treatment goals that could be utilized in this population.

3.

Review the section on Applied Behavior Analysis (ABA). Describe the basic tenants of ABA and some ways/examples it could be utilized in clinical practice.

4.

Explain the relevant information (e.g., symptoms, frequency, intensity, duration, assessments) needed in a well-written medical consultation referral for someone who you believe may be suffering from a neurocognitive disorder.

5.

Review the case study of Melinda (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reactions to Melinda including her lived experiences, her problems/ difficulties, and her actions/ behaviors ● Describe her (C) contextual assessment ● Describe her (A) assessment and diagnosis ● Describe her (N) necessary level of care

18

●

Describe her (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Melinda Compare and contrast your answers with the I CAN START model write-up at the end of the chapter.

6.

Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions.

Use the two creative toolbox activities within the chapter as a guide.

7.

Review the additional case vignette provided. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the one at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely, and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

Chapter 14: Dissociative Disorders and Somatic Symptom and Related Disorders Discussion Questions and Activities 1.

Define and give examples of dissociative symptoms. What disorders have dissociative components?

How are dissociative identity disorder, schizophrenia-spectrum disorders, borderline personality disorder, neurocognitive disorders, and trauma-related disorders (i.e., PTSD, ASD) differentiated?

2.

Review the dissociative identity disorder treatment section. Explain how a phase-oriented approach can be integrated with an insight oriented, dialectical behavioral therapy, behavioral therapy, acceptance therapy, or cognitive behavioral therapy. Present some specific examples of how a phase-oriented approach could be integrated with any of the previously mentioned approaches.

3.

Consider a time when you had physiological complaints and/or pain over the course of your lifespan.

Reflect on how long you felt like this: were there any precipitating events?; how intense were your pain/feelings/emotions?; what kinds of thoughts did you have during this time?; how did you interact and relate to others?; and what aided and helped you in feeling better? Using these reflections, consider how this may aid you in working with someone who is suffering from physical complaints and/ or pain.

4.

Discuss how the use of cognitive behavioral therapy would look in treatment with an individual with illness anxiety disorder. Additionally, provide possible examples of statements and questions that utilize this approach with this population.

5.

Review the case study of Stephanie (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reactions to Stephanie including her lived experiences, her problems/ difficulties, and her actions/ behaviors ● Describe her (C) contextual assessment ● Describe her (A) assessment and diagnosis ● Describe her (N) necessary level of care ● Describe her (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions ● List any additional (T) therapeutic support services for Stephanie Compare and contrast your answers with the I CAN START model write-up at the end of the chapter.

6.

Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative

19

activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions.

Use the two creative toolbox activities within the chapter as a guide.

7.

Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

Chapter 15: Sleep-Wake Disorders, Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria Discussion Questions and Activities 1.

Review the section on insomnia. How might you present some of the major components of sleep hygiene to a client who has insomnia? Practice the essential components of this psycho-educational approach with another classmate.

2.

Review the section on paraphilic disorders. Do you have any personal reactions to any of the specific paraphilia? Explain your reaction. Would you find it difficult to treat a person with that disorder(s)?

How would you manage your personal reactions?

3.

Imagine you have a client who is seeking treatment to increase his or her frequency and desire to engage in sexual activities. The client has come at the urging of a romantic partner, but is not really sure what can be done about this situation. Do you have any personal reactions to this scenario? Would you feel differently if the client were male? What if the client were female?

4.

Review the gender dysphoria section. Using the Internet, find and review current World Professional Association for Transgender Health (WPATH) Standards of Care.

5.

Review the case study of Mr. Jones (at the beginning of chapter) and briefly summarize the following components of the I CAN START model: ● Reflect on your own (I) personal reaction to Mr. Jones including his lived experiences, his problems/ difficulties, and his actions/ behaviors ● Describe his (C) contextual assessment ● Describe his (A) assessment and diagnosis ● Describe his (N) necessary level of care ● Describe his (S) strengths, capacities, and resources (at the individual, family, and community levels) ● List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions. ● List any additional (T) therapeutic support services for Mr. Jones.

Compare and contrast your answers with the I CAN START model write-up at the end of the chapter.

6.

Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions.

Use the two creative toolbox activities within the chapter as a guide.

7.

Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

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Additional Case Studies Chapter 4 Case Study: Chad Chad, a nine-year-old Caucasian male, lives in an urban, lower-middle class home with his mother and older sister. Chad’s father died when he was a young child and according to his mother, Chad never verbalizes any thoughts or feelings about his father. Chad’s mother provides for the family financially. She works at a local dog kennel and occasionally picks up weekend shifts at a local grocery store. Chad’s mother is seeking treatment for him -and the family- per the recommendation of the school counselor.

Chad’s mother describes her son as being extremely emotionally reactive. He often has verbal outbursts over the simplest request. He spends a great deal of his time in solitude and appears irritable most of the time.

Many of Chad’s outbursts happen within the home. Recently, Chad became frustrated with his older sister, Eva, when she would not allow him to use the family computer. Chad attacked her and left scratch marks all over her face. These outbursts often occur when Chad is denied something he wants. For example: dessert instead of dinner or to be selected as line-leader at school. Chad’s mother reports that when she says “no” Chad “flips out” and screams, cries, swears, and uses physical aggression such as hitting or grabbing until she gives in to his request. Aside from these outbursts, Chad is persistently irritable and shouts answers to even the simplest questions and he frequently instigates arguments.

Additionally, Chad has outbursts at school. Frequently, Chad has issues with other students, teachers, and administrators. These interpersonal difficulties may account for his grades which are lower than would be expected for his intelligence level. Chad’s mother states that when she asks him to complete his homework assignments he refuses. These discussions usually result in a verbal altercation ending with Chad storming into his bedroom. Chad’s mother also reports that she suffers from ADHD, which sometimes affects her ability to track her son’s assignment completion. Chad’s teachers have scheduled many conferences with his mother because he is underperforming in three classes (i.e., reading, science, and math). Teachers have conveyed to her that Chad has an above-average intelligence and should be performing better in these classes. His teachers also report that he engages in verbal conflicts with school authority figures mainly over his disruptive behavior in class (e.g., talking out of turn, defiance). According to Chad’s mother, Chad has been expelled from a previous school for verbally threatening a teacher and suspended from his current school for threatening a classmate.

Chad’s struggles encompass life beyond school. Socially, he has few friends and often loses friends secondary to his inability to control his temper. Chad’s mother reports that he seems to isolate himself from others. For example, his mother reports that Chad used to play basketball with other kids in the neighborhood, but has not done so for about eight months. Chad’s mother reports that his normal after school routine consists of “him coming home from school every day and storming upstairs.” He then plays video games all afternoon and evening, and rarely joins the family for dinner. Because of his recurrent temper outbursts, his mother has resorted to leaving Chad in his room for hours. She states, “at least then I can have some peace and quiet.”

Chad denied manic episodes, psychotic symptoms, and suicidal ideation. Additionally, he states he has never used or abused substances. Chad’s mother reports that these temper outbursts began when he was seven years old. She says that his irritable mood occurs most of the day nearly every day, and his outbursts occur about three to five times per week. She states that her brother is invested serving as a “role model” for Chad and visits his nephew once a month to play basketball or take Chad out for a few hours.

Treatment Plan for Chad The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Chad.

C = Contextual Assessment Chad is nine-year-old Caucasian male who lost his father at an early age. He appears to use anger and aggression to deal with his frustration, irritability, and difficult situations. Chad’s mother is invested and involved in his life, but doesn’t seem to know how to support him through his frustrations. Chad’s mother struggles with her own mental health concerns (i.e., ADHD). Chad’s family lives in an urban, lower socioeconomic status area and has to navigate poverty and limited access to resources and services, yet all of Chad’s basic needs are met.

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A = Assessment and Diagnosis Diagnosis = Disruptive Mood Dysregulation Disorder 296.99 (F34.81) N = Necessary Level of Care Outpatient, family counseling (once per week) Outpatient, individual counseling (once per week) S = Strength-Based Lens Self: Chad appears to be of above average intelligence and his teachers indicate that he could be a strong student. He seems willing to utilize counseling services.

Family: Chad’s mother appears to be a loving and supportive. Although he recently was aggressive with his sister, he appears to have a good relationship with her and with his extended family. His uncle is invested in Chad’s development and well-being. He is a positive male role model and a social support.

Community: Chad and his family live in an urban area and there are parks, transportation, therapeutic resources (e.g., YMCA) and activities within walking distance.

T = Treatment Approach Parent Management Training (PMT) – Family Problem-Solving Skills Training (PSST) – Individual A = Aim and Objectives of Treatment (60-day objectives) Family (PMT): Chad’s mother will become more aware of her interactions with Chad Chad’s mother will record her interactions with Chad in her treatment journal 3 times a week. When she records interactions that involve Chad’s outbursts or tantrums, she will record: (a) the antecedent or precursors to the situation that brought on the verbal outburst, (b) her and Chad’s behaviors in the situation, and (c) the consequences of those behaviors.

Chad’s mother will increase her use of positive reinforcements Chad’s mother will attempt to utilize at least 1 positive reinforcement (praise, individual attention, reward, additional privilege) when Chad is interacting positively (with her or with his sister) and will do this 90% of the time.

Chad’s mother will implement a token economy within the home She will select 3 behaviors she would like to target (e.g., being respectful to his sister, no tantrums, eating dinner with the family) and a visual reward system that consist of a means to earn extra privileges and prizes. This will be displayed in a central area and be updated every day.

Individual (PSST): Chad will begin to develop more effective problem-solving behaviors in times of frustration Chad will slow down, stop and think, and generate at least two alternative solutions to a frustrating situation avoiding verbal or physical aggression 80% of the time.

R = Research-Based Interventions (based on PMT and PSST) Counselor will help Chad’s mother develop and apply the following skills: becoming more aware of parentchild interactions, increasing use of positive reinforcements, using a token economy, shaping behaviors, appropriate use of punishment, knowing when to attend to behaviors and when to ignore behaviors, and implementing learned skills through role-play in sessions.

Additionally, the counselor will help Chad develop more effective problem solving and decision-making skills through the use of role playing activities, coaching techniques to model more positive problemsolving skills, positive reinforcement, and corrective feedback on ways to handle future situations.

T = Therapeutic Support Services ● Medication evaluation with a psychiatrist ● Weekly individual counseling ● Possible involvement in an athletic league (e.g., YMCA youth basketball league) for more social support ● Possible involvement of the school counselor for school-based interventions 22

Chapter 5 Case Study: Joseph Joseph is a 65-year-old, Native American (of Cherokee decent) who recently retired after 30 years working in higher education as an anthropology professor. He has a strong cultural identity and is married with two adult daughters. Joseph’s daughters are married and live in different parts of the country, yet they remain extremely close with Joseph and he regularly speaks with them both. During his time in academia, he was confident, motivated and dedicated to his work. He was hard-working, punctual, and rarely missed work.

Throughout his career and until retirement, he wrote and made presentations across the United States. Joseph reports that he has been looking forward to “slowing down a bit” during his retirement and “doing all the things he did not have time for” with his wife Nancy to whom he has been married for 46 years.

Upon retirement, and with a new routine, Joseph feels “disoriented.” He reports feeling anxious about his “open schedule” and about going and “meeting new people” in the community. The new feelings of anxiety started to gradually escalate in the first few months after he retired. Joseph states he feels this anxiety when he is around other people. As a professor, he was often anxious to be in front of a class, but he focused on teaching the material and this enabled him to deal with his anxiety. Currently, without this type of distraction, his focus is more so on himself. Due to a recent decline in his vision and hearing, Joseph reports persistent and pervasive thoughts that others are judging and evaluating him as being disabled.

Joseph feels trapped because he doesn’t want to leave his home or be around others, yet his wife wants them to engage in more extracurricular leisure activities such as attending concerts, painting and sculpture classes, and catching up with family and old friends across the country. A week after his retirement, Joseph and his wife made a trip to Yellow Stone National Park and he felt relief when they arrived at the park and were secluded away from other people.

Joseph reports that he is unsure “what is going on with him” and because of his wife’s advisement he is willing to see if counseling could be helpful. He reports not only declining physical symptoms, but also feelings of hopelessness that he will never fully enjoy the retirement he dreamed of for so many years. He reports feeling trapped. He says that he only feels safe in his home and that even when he is in his yard, in a crowd, or in line at the grocery store he feels overwhelmed by this intense anxiety that he is being judged or evaluated by others.

Treatment Plan for Joseph The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Joseph.

C = Contextual Assessment Joseph is a 65-year-old Native American with a strong sense of family and cultural heritage. He has been married to his wife for 46 years and recently retired as a college anthropology professor.

Secondary to retirement, he is transitioning into a new phase of life. During this transition, Joseph started to struggle with feelings of hopelessness stemming from thoughts that others were/are evaluating and judging him. Physically, he began to experience a decline in his vision and hearing and this may be exacerbating his social anxiety.

A = Assessment and Diagnosis Diagnosis = Social Anxiety Disorder 300.23 (F40.10) N = Necessary Level of Care Outpatient, individual counseling (once per week) S = Strength-Based Lens Self: Joseph is an intelligent, insightful, and thoughtful individual. He is reliable, devoted, driven, and hard working. He possesses multiple educational degrees and has been gainfully employed for over 30 years in higher education. He is passionate about his culture, his family and desires to enjoy his retirement.

Family: Joseph enjoys a close relationship with his wife of 46 years. She is a loving, dedicated, and invested in his well-being. Additionally, he is extremely close with his daughters and speaks with them regularly.

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Community: Joseph has a strong cultural identity and feels connected to his family, his community, and his ancestors. He has long-standing relationships with colleagues, yet secondary to his current isolating behaviors he has not connected with these individuals recently.

T = Treatment Approach Cognitive Behavioral Therapy (CBT) with Relaxation Training and Exposure-Based Interventions A = Aim and Objectives of Treatment (90-day objectives) Joseph will increase his ability to tolerate his social anxiety and discomfort Joseph will utilize at least one relaxation technique (e.g., deep breathing, progressive muscle relaxation) when he begins to feel overwhelmed by his intense social anxiety. He will utilize this learned relaxation skill 100% of the time.

Joseph will learn to identify and challenge cognitive distortions related to his social anxiety Joseph will utilize cognitive restructuring to examine his thoughts/beliefs (e.g., “people are judging me and think I’m disabled”), evidence-review of the accuracy of those thoughts/beliefs, and engage in behavioral experimentation of an alternative and more accurate thoughts/beliefs 80% of the time.

Joseph will increase his ability to tolerate situations which evoke social anxiety Joseph will create a hierarchy of stimuli that cause anxiety and discomfort (e.g., being in his yard, going to the grocery store, standing in a line). He will gradually be exposed to these situations and resist avoiding them at least 75% of the time. He will learn how to tolerate these situations and the thoughts that he associates with them. He will realize that they do not produce the horrible outcomes which dominate his thoughts.

R = Research-Based Interventions (based on CBT) Counselor will help Joseph develop and apply the following skills: ● Challenging cognitive distortions ● Accepting and tolerating anxiety ● Applying relaxation skills Counselor will help Joseph with effective utilization of cognitive restructuring techniques. This restructuring will focus on his thoughts and his anxiety and any misconceptions of how he thinks others view him.

T = Therapeutic Support Services ● Medication evaluation with a psychiatrist ● Weekly individual counseling ● Social anxiety support group

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Chapter 6 Case Study: Cindy Cindy, a 46-year-old, biracial female, is a single, stay-at-home mother with three older children. Cindy has always been reluctant to discard her possessions. She reports this has always been the case even though her parents were extremely strict and forced her to keep a tidy bedroom. During adolescence, she would often hide her possessions such as papers, drawings, and dolls under her bed or in the back of her closet. When she married her husband, Dan, she maintained an uncluttered home in order to appease him. However, when Cindy’s marriage deteriorated, and Dan divorced her, Cindy started storing her possessions which included a variety of items like holiday decorations, clothes, shoes, and plastic food storage containers. She reports that the divorce was devastating and created a sense of identity confusion and loss which led her to question her own self-worth.

A collection of excessive possessions gradually cluttered her home. Bags and boxes piled high in every room have left her with only a small pathway to access adjacent rooms. Several rooms in Cindy’s home are inaccessible because of the clutter. She sleeps among newspapers and books that she has accumulated in her bed. She goes to the local grocery store on a daily basis to pick up multiple newspapers from the previous day.

She is also extremely fearful of not having enough food so she also keeps her basement stocked with large amounts of food in case of a major weather event. Much of the food stored in her basement and refrigerator has expired but she feels like she is being wasteful if she discards any of it. Her refrigerator is filled with moldy and rotting food, and her children complain about being served “rotting food.”

She is extremely indecisive. Cindy not only finds it difficult to part with her old school papers, her children’s baby clothes, and other sentimental items from her past, but she has difficulty deciding what should be discarded and is fearful that she will need that item in the future.

Cindy’s ex-husband, concerned that the clutter was a fire hazard with children living in the home, contacted Children’s Services. However, before the visit, Cindy hid some of her possessions in the attic, crawl space, and garage. The social worker dismissed the case. Two years later, Cindy’s ex-husband called Children’s Services again after one of their children slipped on some papers, fell down the stairs, and was taken to the hospital for a minor concussion. At that point, Cindy was referred to counseling.

Cindy demonstrates insight into her problematic behavior and has expressed a desire to change. She feels responsible for her daughter’s concussion and her son’s difficulty making friends. Nonetheless, Cindy has difficulty controlling her urge to hoard. When her children ask her to “get rid of things” so they can have friends over, the thought of discarding possessions fills Cindy with intense and overwhelming anxiety and prevents her from taking action. Cindy has cleaned her home for two of her children’s graduation parties by moving possessions to the upper part of the house where the clutter would be hidden from guests. However, despite firm resolutions to keep tidy, the house became cluttered again within a week.

Cindy has always been disorganized and indecisive which contributes to her current situation. Mail often accumulates on the counters because Cindy has difficulty deciding which pieces of mail to keep and she is unsure where to file important documents. Aside from her hoarding behavior, Cindy is an invested and caring mother to her children. However, she lacks social support. In the past, she was actively involved in her local church and played the organ/piano for the congregation, but she has not done that for a few years. She would like to get more involved in her church in the future because her Christian faith is important to her. She feels guilty about the problems she has caused her family. She appears committed to moving forward in the counseling process.

Treatment Plan for Cindy The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Cindy.

C = Contextual Assessment Cindy is a biracial female who recently experienced a painful divorce. Developmentally, Cindy is struggling with her own self-worth, her identity as a single woman and the loss of her husband and friend. The stress of these struggles could be exacerbating her current hoarding behaviors, and these issues may need to be integrated into a treatment plan and addressed once her behaviors are stabilized.

She is a caring mother of three older children but seems to lack deep friendships and a healthy support system. Cognitively, she appears to have some difficulties in information processing (i.e., indecisive in discarding non-essential possessions) and lacks a full awareness of the consequences of her excessive 25 © 2019 by Pearson Education, Inc. All rights reserved.

acquisition of materials. Cindy reports that her religious beliefs are important to her and that she is interested in becoming more involved with her church, which will also develop her support system.

A = Assessment and Diagnosis Diagnosis = Hoarding Disorder with excessive acquisition 300.3 (F42.3) N = Necessary Level of Care Outpatient, individual counseling (once per week) S = Strength-Based Lens Self: Cindy is an intelligent, creative, and musically inclined individual. She seems to have some insight into her behaviors and is determined to move forward with treatment. Cindy is motivated to be successful in the future and seems ready for treatment and change. She is a loving and caring mother for her children and this seems to be an essential part of her identity.

Family: Cindy cares about her three children and wants to be a loving, supportive mother to them. Her children are a social support resource for her.

Community: Cindy historically had close ties at her church where she attended services regularly and played the organ/piano for the congregation. She is optimistic that she will increase her involvement with her church in the future.

T = Treatment Approach Cognitive Behavioral Therapy (CBT) A = Aim and Objectives of Treatment (90-day objectives) Cindy will learn to identify and challenge cognitive distortions related to hoarding behaviors Cindy will utilize cognitive restructuring to examine her thoughts/beliefs (e.g., “I need to keep this [nonessential possession]”), evidence-review of the accuracy of those thoughts/beliefs, and engage in behavioral experimentation of an alternative and more accurate thoughts/beliefs 80% of the time. These distortions are often related to beliefs about the possessions, information process deficiencies, and avoidance behaviors.

Cindy will become aware of how her thoughts affect her hoarding behaviors, and she will use skills to change her thoughts and behaviors Cindy will identify and learn two CBT skills (e.g., coping strategies, thought stopping, restructuring) that can be used to help her examine how her thought patterns maintain her hoarding behaviors; she will examine ways to challenge these thoughts and alter behaviors 80% of the time.

R = Research-Based Interventions (based on CBT) Counselor will help Cindy develop and apply the following CBT skills: ● Increasing Cindy’s awareness of her excessive acquisition behaviors (e.g., accumulating day old newspapers) and her difficulty in discarding non-essential possessions ● Identifying and challenging her cognitive distortions related to her hoarding behaviors by utilizing cognitive restructuring (e.g., Downward arrow technique) ● Increasing her decision-making skills regarding her organization, storing, and discarding of possessions within her home T = Therapeutic Support Services ● Medication evaluation with a psychiatrist ● Weekly individual counseling ● Hoarding social support group ● Increased involvement in her local church (e.g., playing the organ/piano)

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Chapter 7 Case Study: Janet

By Chelsey Zoldan LPC (OH) Janet is a 45-year-old Caucasian female. She is currently living with her sister and brother-in-law. Janet is self-referred to counseling for what she described as, “not feeling like myself.” At intake, Janet reported that she was experiencing sadness, irritability, and tearfulness. She recently has also been finding herself more easily irritated with others, and has been getting into arguments with her sister almost daily. Janet also described excessive worry and distress at “feeling out of control of my future” and in handling recent life changes.

Janet shared that she grew up on a farm with her family, which consisted of her mother, father, and little sister, as well as many animals. Janet believes that growing up on a farm contributed to her developing a strong work ethic and a sense of self-sufficiency, as the family was able to provide themselves with food, milk, and other products from their own or neighbor’s farms. Janet is very proud of her upbringing and strongly values responsibility. Janet was divorced approximately 15 years ago after being married for 8 years, and is not interested in pursuing a romantic relationship at this time. Janet does not have any children.

Janet was laid off 3 months ago after working as a heavy equipment operator for 25 years. She began noticing her presenting symptoms after she was laid off and unable to find employment in the subsequent months. Because her job frequently took her to various parts of the country temporarily, Janet decided to move back to her hometown to her sister’s home until she found employment again. Janet pointed out that this is the first time in her adult life that she is unable to financially support herself.

Last week, Janet received a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) and emphysema. Additionally, Janet’s arthritis pain has become more severe. Her primary care physician recommended that she not return to her work in heavy equipment operation, and suggested she find employment in another field. Janet reported, “I was devastated, this has been a huge part of who I am for almost all of my life.” In addition to these stressors, Janet has also been dissatisfied with having to live in her sister and brotherin-law’s home, and would like to find her own housing. However, financial difficulties have hindered Janet from being able to obtain her own home, and she is currently on a waiting list for public housing.

Janet is struggling with her need to receive public assistance, but has decided to “give back” to the community by volunteering at a local food pantry. She shared that she feels better knowing that she is able to “contribute something to the world.” Janet has four close friends who she spends time with, and a dog who she rescued from a local shelter. Janet has a passion for helping others and taking care of animals.

Treatment Plan for Janet The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Janet.

C = Contextual Assessment Janet is a middle-aged woman. She is unemployed after being laid off recently, and has been unable to find work in her field for the past several months. Janet lives in a safe environment where her basic needs are met; however, she would like to move into her own home eventually. Janet believes in God and volunteers at a food pantry located at a local church. She was instilled with values of responsibility for self, independence, self-sufficiency, compassion for others, and a strong work ethic. Janet denies any additional cultural influences or traditions. Janet is navigating the generativity vs. stagnation phase, in which she is struggling between wanting to contribute to her community and factors that hinder her from doing so in the way she has done in the past (e.g., employment as a heavy equipment operator).

She has recently been experiencing declining health.

A = Assessment and Diagnosis Diagnosis = Adjustment Disorder with Mixed Anxiety and Depressed Mood 309.28 (F43.23) N = Necessary Level of Care Outpatient, individual counseling (once per week/every two weeks)

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S = Strength-Based Lens Self: Janet is intelligent, hard-working, kind, independent, and humorous. She is responsible and wants to attend counseling sessions. She shows up consistently to appointments. She is passionate about giving back to her community and making a difference in the world. Janet also has a love for caring for animals.

Family: Janet has typically had a supportive relationship with her sister, until recently when they began living together. Janet’s brother-in-law has been supportive of her, and she values their relationship, and is grateful that he and her sister have allowed her to live in their home. Janet believes that when she is able to move into her own home, her strained relationship with her will return to the way it has always been. Janet’s parents are deceased.

Community: Janet is active in her community through volunteering at a food pantry at a local church.

Janet shared that she enjoyed going to church when she was younger, but does not regularly attend services because she does not enjoy being around large groups of people. Janet has a small but supportive friend base which includes both lifelong friends and new friendships formed through working at the food pantry.

T = Treatment Approach Solution-Focused Brief Therapy A = Aim and Objectives of Treatment (60-day objectives) Janet will generate a list of strengths, resiliencies, and abilities and develop ways to use these to meet goals Client will create a list personal strengths to assist in developing and working toward goals.

Each day she will use 1 identified strength and she will use this strength throughout the day as a coping skill to decrease negative mood symptoms.

Janet will identify three skills that she can use to manage and reduce her negative feelings (i.e., anxiety and depression) Client will identify 3 coping strategies she has used in the past to manage in counseling and she will use these 90% of the time to manage negative mood states.

R = Research-Based Interventions (based on SFBT) Counselor will challenge Janet to think of exceptions to current problems, generate possible solutions, utilize the miracle question to explore client goals, and consider using her unique strengths as solutions.

T = Therapeutic Support Services ● Referral to vocational services to help client find employment or explore other vocational interests ● Weekly to biweekly individual counseling ● Referral to local services to help Janet in learning about public assistance housing and disability benefits

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Chapter 8 Case Study: Michelle

By Chelsey Zoldan LPC (OH) Michelle is an 18-year-old student completing her second semester of college. Throughout her life she has lived in a small rural town approximately 3 hours away from the university she attends. Going away to college was always a dream of hers, but she did not anticipate the lifestyle changes that came with moving away from the comforts of her hometown. Michelle is one of the only students from her high school to pursue a college education.

Michelle’s father is a police officer and her mother is an elementary school teacher. She was raised with strict rules, to which she diligently adhered. She graduated as the valedictorian of her high school class last summer and is described by those who know her as an “over-achiever.” She received a full scholarship to her university upon graduation. Michelle has a younger brother, Michael, who she has a very close relationship with; however, since beginning college, making time to visit or video chat with each other has been difficult.

Michelle feels somewhat disconnected from her friends from home, because she feels that they do not understand her goals for the future. Many of these friends have been starting families, and Michelle feels that she cannot relate.

Michelle is planning on double-majoring in Chemistry and Biology, and dreams of becoming a veterinarian in her home town. Michelle reported that she enjoyed the initial sense of freedom after moving away from the strict rules and routines of home life. While she was nervous about being away from home, she began to make new friends in her dorm, and became involved in many on-campus groups. Michelle began to experiment with alcohol at parties and tried smoked marijuana once. Prior to these experiences, Michelle had never consumed alcohol other than when she was receiving Communion at her church.

Michelle’s grades have begun to drop, and while she still maintains A’s and B’s, this is a marked difference from her usual academic performance. She has been missing classes more frequently due to feeling “hungover” or going to local bars to drink during the day, where she uses a fake driver’s license to buy alcohol.

Michelle has been visiting home less often, and her parents have become worried. They have even threatened to make Michelle drop-out of school “until she gets her act together.” Michelle believes that her family is “trying to punish me for living my life and not doing what everybody expects me to do.” She shared that she wants to drink more often to “stick it to them.”

Michelle stated that she feels that she might have a problem with using alcohol, but is afraid that if she does not continue to drink she “won’t have anything in common with my friends here and I will be too shy to talk with others at parties.” She has decided to attend counseling at her university clinic after a Resident Assistant (RA) in her dorm approached her about having knowledge of alcohol in her room and her underage drinking. Michelle is worried that if she is reported for her alcohol use, she will lose her scholarship and be unable to continue attending the university. After talking with the RA, Lori, she found out that the two had much in common. Lori is also from a small town that coincidentally is not far from Michelle’s hometown, and has offered to share rides to visit home.

Treatment Plan for Michelle The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Michelle.

C = Contextual Assessment Michelle is an 18-year-old Caucasian female who enters counseling after being confronted about her alcohol consumption by a Resident Assistant in her college dorm. She recently ventured away from her hometown for the first time in her life to move away to college, where she is completing her second semester. College has brought about a new sense of freedom and independence that Michelle did not feel that she had at home. Her substance abuse began within the past six months when she began attending parties on campus. She has supportive parents who have high expectations for her and her behavior. However, her expectations for her future are much different from the typical life plans of others in her hometown. Related to this, she has limited her contact with her longtime friends living in her hometown because she believes that they cannot relate to her lifestyle. She has a close relationship with her brother Michael.

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A = Assessment and Diagnosis Diagnosis = Alcohol Use Disorder, Mild 305.00 (F10.10) Assessment = Addiction Severity Index to assess factors contributing to substance use and severity level of use.

N = Necessary Level of Care Outpatient individual counseling (once per week) and group counseling (once per week) with other students struggling with substance use Level of care will be reassessed if substance use increases S = Strength-Based Lens Self: Michelle is self-motivated and high-achieving. She has demonstrated a past pattern of setting goals for herself and being able to excel in achieving them. While she has reported that her upbringing was one characterized by strict rules and routine, she diligently adhered to these, demonstrating her desire to be mindful of her parents’ wishes.

Family: Michelle and her brother have historically had a close relationship.

Community: Michelle now has an opportunity for a healthy friendship with her RA Lori, and also has the chance to share rides home so that she can visit with her brother and family more often.

T = Treatment Approach Motivational Interviewing Cognitive Behavioral Therapy A = Aims and Objectives of Treatment (60-day objectives) Michelle will develop an academic action plan, will follow the plan, and will attend all classes and complete school assignments in a timely manner Michelle will miss 0 classes, unless providing a verifiable medical excuse, and turn in all course assignments on time to restore her grades.

Michelle will utilize healthy sober supports to assist in maintaining sobriety Michelle will pursue friendships with sober friends, such as Lori, and spend time with them at least 2 times per week Michelle will reduce her alcohol intake to 1 use of no more than 3 alcohol units per week ● Michelle will examine the negative consequences of her drinking and will identify 5 of the negative consequences of her drinking. ● Michelle will identify 5 strategies she can use to reduce her drinking. ● Michelle will use her identified strategies 100% of the time to limit her alcohol use to 1 time per week (no more than 3 units).

R = Research-Based Interventions (based on MI and CBT) Counselor will help Michelle to: ● Complete and MI decisional balance sheet ● Explore cognitive distortions surrounding need for alcohol to maintain friendships and interact socially ● Complete stress-management training and acquire new coping skills ● Complete self-control training T = Therapeutic Support Services ● Weekly individual counseling ● Attend 12-Step meetings to learn more about alcohol abuse and its consequences ● Attend a support group on campus for students struggling with adjustment to college

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Chapter 9 Case Study: Courtney Courtney is a 24-year-old Caucasian mother of two. She is currently serving a 20-year sentence for murder at a maximum-security prison. She is eligible for parole in 15 years and already served two years of her sentence. Within the prison, she is seeking a mental health transfer to the prison’s psychiatric ward after a recent suicide attempt which involved her cutting her arms 23 times with a razor.

Throughout her life, Courtney has struggled to form and maintain relationships. She never knew her biological father because he left when she was very young. Her mother told Courtney that her father was a “loser” and she is “better off without him.” Her mother eventually remarried when Courtney was six years old.

Courtney reports she had a violent, turbulent relationship with her stepfather. She felt like her mother was “always aligned with him” and seemed to be “always against her.”

From the age of 10 to 12, Courtney’s stepfather violently and repeatedly sexually abused her. The sexual abuse only stopped after her stepfather died of a heart attack. When Courtney finally had the courage to tell her mother about these brutal acts, her mother called Courtney a “liar” and that her behavior would not be tolerated.

Courtney’s mother physically beat her daughter for making these accusations about her stepfather. At a very young age, Courtney learned from her mother that women were less valuable and more expendable than men.

Courtney would violently act in retaliation when she felt inferior in any situation and this contributed to the development of her many aggressive behaviors.

School was especially difficult for Courtney. Although she was bright, she often had blatant disregard for authority, was at odds with the administration and the culture at her school. She was suspended numerous times before eventually being expelled for a litany of violations including: truancy, fire-setting, smoking in the bathroom, fighting, verbal aggression, and hitting an elderly teacher with a chair.

Courtney reports that she is not even sure if her mother knows she is in prison. She states that her mother was “always on something.” When Courtney turned 17 years old, she ran away from home and never returned.

During this time, Courtney experienced a string of destructive relationships with men often ending in physical altercations and violence. She had two children with two different men and reports that she was not available or able to care for them because she was out partying or looking for her “on-again-off- again boyfriend, Ted.” She reports that she would leave her children with Terri, her only friend who was often Courtney’s only “voice of reason.” Terri currently is pursing adoptive rights for Courtney’s children.

One night in late October everything changed. Courtney found out that “Ted was sleeping with Susan,” one of her former friends. Susan and Ted started seeing each other when Courtney was in jail on an assault charge.

Courtney conspired to confront Ted at Susan’s house. As she drove up to the Susan’s house, Courtney saw Ted walking out of Susan’s home. Susan waited for Ted to walk out to his car. Courtney then proceeded to slam on the gas and hit him with her car. Courtney initially hit him and then ran him over repeatedly before fleeing the scene. He died shortly after at a local hospital. Courtney was eventually convicted of second-degree murder due to the seriousness of the aggravated assault.

In prison, Courtney can be personable and charismatic at times yet most of the time she seems to be irritable and aggressive. She reports that she suffers from nightmares, avoidance and has a negative disposition. She feels, no one is to be trusted and the world is dangerous. Courtney desires to reconnect with her two children but has not heard from Terri (her friend who is taking care of them). Courtney seems to have a few friends in the general population and has started to take classes to obtain her GED. Additionally, she has started to attend religious services on Saturday evenings. Unfortunately, she has also been involved in three fights over the last year and instigating a riot when the institution went smoke-free. She appears to lack remorse for most of her aggressive acts often believing that others “deserved that” and is often unable to take others’ perspectives in situations “she should of known better than that.” Courtney is now seeking counseling services with the prison’s mental health department and is looking to be transferred to the psychiatric ward.

Treatment Plan for Courtney The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Courtney.

C = Contextual Assessment Courtney grew up in an abusive home and has continually struggled to feel attached to her mother.

Currently, she is unattached to her own children and is in jeopardy of losing her parental rights. Courtney 31 © 2019 by Pearson Education, Inc. All rights reserved.

has gender considerations secondary to the devaluation of women, abuse of women, and victimization by men in authority roles (i.e., her stepfather) she experienced when she was a child. Courtney struggled to form and maintain lasting relationships and seems to experience a great deal of frustration an angst in relationships. Cognitively, she continually violates the rights of others and finds it difficult to understand other’s perspectives. Courtney has recently started to attend religious services and seems to find comfort in religion.

A = Assessment and Diagnosis Diagnoses = Antisocial Personality Disorder 301.7 (F60.2) Posttraumatic Stress Disorder, Unspecified 309.81 (F43.10) N = Necessary Level of Care In a controlled environment (i.e., maximum-security prison) Individual counseling in general population (once per week) S = Strength-Based Lens Self: Courtney is a bright, personable, and charismatic individual. She is a survivor as she has experienced a great deal and continues to be resilient. She is attempting to pursue educational and religious opportunities in an attempt to move forward academically and spiritually. She has consistently protected herself from others and from future abuse even though this is often aggressive in nature.

Family: While Courtney was an unreliable mother to her children, she desires to be reconnected with them and to be part of their lives in some way.

Community: Within a controlled prison environment, Courtney is afforded medical, mental health, educational, vocational, and growth/development opportunities. She has a few friends in prison and the community affords her the opportunities to engage in a number of controlled extracurricular activities (e.g., yoga, recreation, non-violent communication trainings, religious services).

T = Treatment Approach Schema Therapy (ST) A = Aim and Objectives of Treatment (3-month objectives) Courtney will build self-awareness and cultivate mindfulness Courtney will identify her emotional states and be more aware of how they are activated in different situations (e.g., when she feels inferior she often becomes aggressive) 80% of the time. She will work to be more observant of her behavior when these situations arise in order for her to not get distracted or overly influenced by her emotional states.

Courtney will build an understanding of how her maladaptive schema (e.g., unmet safety, acceptance, and respect needs) impact her thoughts, feelings, and behaviors Courtney will confront and challenge her cognitive distortions (which are the beliefs, assumptions, and thoughts) that maintain the maladaptive schema on the basis of reason and the examination of the evidence 80% of the time.

Courtney will develop a clear sense of her own identity Each day, Courtney will complete structured writing activities in her reflective diary which will help her explore her thoughts, feelings, behaviors, schema, and increase her ability to accept different perspectives.

R = Research-Based Interventions (based on ST) Counselor will utilize imagery rescripting with Courtney to revise difficult childhood memories associated with her mother and to clarifying the connection between those memories and her current triggers.

Counselor will aid Courtney in constructing flashcards to help her address and plan for difficult situations (e.g., issues with roommate, being in prison) that often happen between counseling sessions.

Counselor will utilize diaries to help Courtney explore her thoughts, feelings, behaviors and schema, as well as asking her to assume others’ perspectives as she explores each situation.

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T = Therapeutic Support Services ● Weekly individual counseling ● Medication evaluation with a psychiatrist ● Support trauma group/sexual abuse groups ● Extracurricular activities (e.g., GED classes, religious services, yoga, recreation)

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Chapter 10 Case Study: Elena

By Chelsey Zoldan LPC (OH) Elena is a 28-year-old Hispanic female. She presented at a local mental health clinic after being referred by her obstetrician and a local inpatient psychiatric facility. Elena gave birth to twins 5 weeks ago after a difficult pregnancy. She and her husband Jayson are first-time parents.

Elena began to engage in strange behaviors approximately 4 weeks after giving birth, such as checking the locks on the doors multiple times per day and keeping the blinds closed at all times. She reported that she does this because people are conspiring to kidnap her children. She has been refusing to leave her children unattended for any reason, even going an entire night without sleeping so that she could watch them. Elena’s delusions have kept her from allowing friends and some family members from visiting with the babies, as she fears that they “are in on the plan to take them away from me.” A neighbor came over to congratulate the new parents with cupcakes and was met with Elena’s suspicions that the neighbor was “poisoning the cupcakes to make me fall asleep so that they can take my babies.”

Elena’s husband and mother believed that the symptoms were possibly just an exaggerated response to new parenthood, but decided to inform the doctor after Elena refused to attend a doctor’s appointment or leave the house for any reason. Elena also attacked Jayson after he left the room when it was his turn to watch the babies, and she accused him of wanting the children to be abducted. Elena was admitted to an inpatient psychiatric facility for 3 days to stabilize her condition with medication and was referred for follow-up care.

Elena has been working in insurance sales for the past 6 years, and is regarded highly within her company as a top salesperson. She has a bachelor’s degree in business administration, making her the first person in her family to go to college. She is very creative and enjoys writing in her spare time. Elena also has close relationships with her family members and is proud of her Hispanic heritage. She also regularly attends church and is a practicing Catholic.

Treatment Plan for Elena The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Elena.

C = Contextual Assessment Elena has strong social supports including her husband, parents, extended family, and her cultural and religious community. Elena has a Hispanic background, and her husband is Caucasian. She has just become a new mother of twins after the stress of a difficult pregnancy. Elena had to take much time off from the job – which she loves - because of pregnancy complications prior to giving birth. She is successful at work, and in terms of their socioeconomic status, she and her husband can be classified as middle-class.

A = Assessment and Diagnosis Diagnosis = Brief Psychotic Disorder with postpartum onset 298.8 (F23) Assessment = Elena will be administered the Clinician-Rated Dimensions of Psychosis Symptom Severity scale (APA, 2013). This will provide a severity rating for this psychotic episode, and also can allow for comparison across time if administered multiple times. Elena will also need ongoing evaluation for the need of psychiatric medications to continue stabilization.

N = Necessary Level of Care At present, the most appropriate and least restrictive level of care is outpatient treatment.

Elena was recently released from a psychiatric hospitalization after being stabilized, and if her condition deteriorates, an increased level of care must be considered.

S = Strength-Based Lens Self: Elena is hard-working and determined. She had a high level of functioning before these symptoms presented. She is the first in her family to attend college and obtain a college degree. She is creative and loves to write. She is a talented salesperson, and well respected at her company.

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Family: Elena has been married for 2 years and has a healthy and supportive relationship with her husband Jayson. Although Elena experienced a difficult pregnancy, both she and Jayson were excited and overjoyed with the prospect of starting a family. Elena has close relationships with her mother, father, and several aunts, uncles, and cousins. Her family members have expressed the desire to be involved in her treatment and in helping her to take care of her new babies.

Community: Elena has a strong connection to the Hispanic community. She identifies herself as Catholic, and regularly attends church. Faith was highly valued throughout Elena’s upbringing.

Although Jayson does not identify himself as a particular faith, he has been supportive of Elena’s religious affiliation and attends church with her.

T = Treatment Approach Elena has achieved stabilization at the present time after receiving inpatient psychiatric care. Outpatient counseling and medication management services are recommended. Treatment approaches utilized will include: psychoeducation, cognitive behavioral therapy to enhance coping skills, and psychopharmacotherapy.

A = Aims and Objectives (60-day objectives) Elena will attend all counseling, psychiatric, and other medical-related appointments Elena will attend weekly/twice-a-week session with counselor, missing 0 appointments. She will attend weekly appointments with psychiatric medication provider, missing 0 appointments. She will also attend her scheduled appointments with her obstetrician, missing 0 appointments.

Elena will develop coping skills to assist her in managing psychotic experiences ● Elena will learn two skills she can use to test the accuracy of her delusions and she will use these 100% of the time. ● Elena will learn two anxiety management skills and apply these 100% of the time when she is feeling anxious.

Elena will re-engage in involvement within her community and with her family members ● Elena will allow family members to spend time with her and her babies a minimum of three times per week until symptoms demonstrate a reduction of 90%. She will use her learned anxiety management skills to help her achieve this goal. ● She will attend church 1 time per week, returning to her previous attendance patterns.

R = Research-Based Interventions (CBT and Psychopharmacotherapy) Counselor will provide psychoeducation to Elena to help her in understanding the onset of symptoms.

Changes in symptom severity will be closely monitored. Counselor will encourage Elena to attend psychiatric medication evaluation appointments and monitor attendance. Counselor will engage in helping Elena to challenge delusions.

T = Therapeutic Support Services ● Medication management by psychiatric medication provider ● Weekly to twice-weekly individual counseling

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Chapter 11 Case Study: Denine

By Chelsey Zoldan LPC (OH) Denine is a 31-year-old married African American female with two children, ages 3 and 1. She was referred to counseling by her primary care physician after her most recent physical examination. Denine reported that she was very reluctant to talk about her bingeing, as she feels a great deal of shame and embarrassment. The client reported that she will consume a high amount of food/calories in a short period of time at least twice each week. She believes that her binge eating is triggered by negative emotions, and cited that her last binge, yesterday, followed being reprimanded at work for a minor mistake. Denine feels immense guilt after bingeing, and feels that she has “totally lost all control” of herself. She typically binges in her car, where she is not around others.

Denine works for a vending company and stocks local vending machines in her area. She is able to eat for free at work, which she shared makes it easier for her to collect sweets and other high calorie foods that she likes to consume during binges. Denine’s husband recently went back to college and is no longer employed, so she has become the financial provider for the family. This role has placed a lot of strain on Denine’s relationship with her husband, and she “feels like a huge weight is on my shoulders now.” Denine shared that she wants to be able to provide for her children to have new toys and things that they want as they get older, and never have to want for things like she did during her childhood.

Denine reported that she has been overweight since childhood, and that her mother died when she was a teenager after having a heart attack. She shared that her father also has health complications related to being overweight.

Denine is embarrassed by her weight, and cried as she expressed her fears about dying young and leaving her children behind. She also worries that as her children age, their friends will make fun of her weight.

Denine’s social interaction with others is limited, and she shared that she worries about others judging her appearance in public. She shared that when she has been grocery shopping, people will “make comments as I walk by, calling me names or making fun of my weight.” Denine pointed out that these comments make her feel bad about herself, and often trigger her to binge.

Denine has several supportive people in her life, including her father, brother, and several extended family members. She regularly attends church on Sundays with her family and enjoys singing in the choir.

Denine also enjoys reading and taking her children to the library.

Treatment Plan for Denine The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Denine.

C = Contextual Assessment Denine is a young, married African American female. She is struggling with self-image issues and reconciling societal ideals of beauty with her own. She is juggling many roles, as a mother, wife, employee, and provider. Financially, Denine is near the poverty level, but she lives in a safe, middle class community. She struggles with feelings of needing to “keep up with” others in her community in terms of what she provides her children with. She identifies herself as a Christian, and regularly attends church.

A = Assessment and Diagnosis Binge-Eating Disorder 307.51 (F50.81) N = Necessary Level of Care Outpatient, individual (once per week/every two weeks) and group therapy every two weeks.

S = Strength-Based Lens Self: Denine is creative, a talented singer, religious, and a good mother. She is intelligent and loves reading to expand her knowledge of the world. She has been dedicated to overcoming the poverty that she has lived in her whole life.

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Family: Denine has a supportive family and is dedicated to caring for her children. She is financially supporting her family as her husband pursues his career interests. Denine’s father, brother, and extended family are supportive of her. Her entire family is together at least once a week, on Sundays, when they attend church together.

Community: Denine lives in a safe middle-class suburban area. She has access to healthcare and other community resources. Denine is able to be an active member in her local church, where is able to engage in her passions for singing and worship by participating in the choir on Sundays.

T = Treatment Approach Enhanced Cognitive Behavioral Therapy for Eating Disorders (CBT-E) A = Aim and Objectives of Treatment (3-month objectives) Denine will learn skills and will use these skills to prevent bingeing coping skills 100% of the time and will have 0 episodes of bingeing.

Denine will use 2 learned

Denine will identify and challenge cognitive distortions related to food and body Denine will identify 5 cognitive distortions she regularly uses and will modify these cognitive distortions using cognitive disputing techniques she learns in counseling at least 70% of the time.

Denine will continue to engage in prosocial activities that she enjoys and that give her menaing Denine will continue to attend church weekly and sing in the choir. She will also continue to make time to read at least twice per week for 30 minutes.

R = Research-Based Interventions (based on Enhanced Cognitive Behavioral Therapy for Eating Disorders) Counselor will help Denine to learn new coping strategies such as thought-stopping, identifying and challenging maladaptive thoughts, and replacing maladaptive cognitive distortions.

T = Therapeutic Support Services ● Continue regular services with primary care physician ● Referral for initial psychiatric evaluation for potential medication ● Referral to nutritional services ● Weekly to every-other-week individual counseling ● Every-other-week group counseling for binge-eating disorder

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Chapter 12 Case Study: Sachin Sachin, a 22- year-old Indian American, is a recent graduate of a prestigious business school. He comes from an affluent family in a high socioeconomic status and has a strong cultural heritage. His family is Hindu, yet Sachin states he is only “mildly interested in religion.” Currently, he is employed with an investment firm and is in charge of attaining new clients. He states that his friends and colleagues perceive him as intelligent, passionate and charismatic yet he reports, “not feeling that close with any of them.” For the last two years, Sachin has been an avid runner. He recently participated in the Richmond and Boston Marathons. Sachin was also recently arrested for property destruction at his girlfriend’s apartment complex when he threw her reclining chair off her fourth- floor balcony.

Even during childhood, Sachin had numerous interpersonal difficulties at school and at home. He would have outbursts that often resulted in furniture destruction, property damage, or even physical altercations.

The altercations were often with family members or nannies, babysitters or other house staff. In high school, he verbally erupted at a teacher making her cry in front of the whole class. Sachin’s parents are powerful and influential. They are often able to resolve and mediate any issues with the authorities so his outbursts did not significantly damage Sachin’s standing or reputation in the school or the community.

Recently, Sachin reports that the frequency and intensity of his outbursts reoccur more regularly.

Additionally, Sachin’s girlfriend has called the police on two separate occasions because Sachin damaged her property and directed aggression toward her. She reports that he is frequently verbally aggressive but “once [his] anger passes he returns back to normal.”

Sachin struggles with controlling his aggressive outbursts. His behavior has led to court-mandated counseling sessions. Sachin has some insight into these outbursts. He reports that most of the time his anger seems to “come out of nowhere” and usually only lasts for “15 to 20 minutes.” He states that “for some reason” unknown to him, his anger is often directed at either his close family members or his girlfriend. He reports that he sometimes gets physically destructive, while other times he tends to be only verbally aggressive. He says he feels “relief” after either of these outbursts. Sachin denies substance abuse, but does report frequently engaging in alcohol consumption.

Treatment Plan for Sachin The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Sachin.

C = Contextual Assessment Sachin is an Indian American with a strong cultural identity. He comes from an influential and affluent family (i.e., higher socioeconomic status). Although he identifies as a Hindu, spirituality is not overly important to him. Throughout Sachin’s childhood and early adulthood, his parents have enabled his aggressive outbursts to persist by mediating and using their resources to temper his repercussions until his most recent arrest. His anger and outburst have always complicated his social relationships, but now jeopardize his occupation and finances due to these recent legal matters.

A = Assessment and Diagnosis Diagnosis = Intermittent Explosive Disorder 312.34 (F63.81) Assessment = SASSI (Miller, 1985) to assess for substance use/abuse and any related treatment that may be necessary N = Necessary Level of Care Outpatient, individual counseling (once per week) S = Strength-Based Lens Self: Sachin is an intelligent, passionate, and personable individual. He is driven and motivated to be successful and is currently employed full-time with an investment firm. Sachin is an avid runner who has competed in marathons. This appropriate outlet may be useful and enable him to deal with his frustration and anger.

Family: Sachin’s girlfriend and family are both a source of social support. They are committed to his treatment and want to support him during this time.

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Community: Sachin lives in a safe, stable community with his girlfriend and has access to health care resources. He has numerous friends, but does not feel particular close with any of them. He enjoys his work and appears to enjoy his colleagues.

T = Treatment Approach Cognitive Behavioral Therapy (CBT) A = Aim and Objectives of Treatment (30-day objectives) Sachin will learn anger management skills he can use to divert his anger and frustration more appropriately Sachin will learn to identify 10 anger cues (e.g., racing thoughts, warming feeling in his face, tightening in his body) and implement at least one identified coping strategy (e.g., walking away, playing music, going for a run, relaxation techniques) 100% of the time when he begins to feel frustrated or feels anger coming on.

Sachin will learn to identify and challenge cognitive distortions related to his anger Sachin will utilize cognitive restructuring to examine his thoughts/beliefs (e.g., “I can’t control my anger;” “I’m powerless”), evidence-review of the accuracy of those thoughts/beliefs and engage in behavioral experimentation of an alternative and more accurate thoughts/beliefs 90% of the time.

R = Research-Based Interventions (based on CBT) Counselor will help Sachin develop and apply the following CBT skills: ● Learning and utilizing healthy coping skills/ strategies ● Challenging his cognitive distortions ● Tolerating his angry and frustration appropriately without having outbursts ● Learning and utilizing relaxation skills Counselor will utilize cognitive restructuring techniques with Sachin. This restructuring will be aimed at his thoughts and misconceptions about his anger and his own overestimation of his lack of control over his behaviors.

T = Therapeutic Support Services ● Medication evaluation with a psychiatrist ● Weekly individual counseling ● Anger management group

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Chapter 13 Case Study: Tonya

By Chelsey Zoldan LPC (OH) Tonya is a 23-year-old biracial female presenting to counseling as a follow-up condition of her being released from an inpatient psychiatric unit. At the intake session, Tonya reported that her mother was her guardian, as she had been diagnosed with an intellectual disability as a child. She reportedly suffered from a fractured skull at one week of age, after her biological father assaulted both she and her mother. Additionally, her mother reported drinking alcohol and smoking cigarettes regularly during her pregnancy with Tonya.

Kate is frustrated with her daughter’s recent behavior, as Tonya has been inviting various men she has met on the internet into their home. Her mother worries about their safety and feels that these men are “using my daughter and she doesn’t understand.” Tonya shared that a man that she invited into their home stole Kate’s wedding ring last month. Kate has tried talking to Tonya about her discomfort with her inviting these “friends” into their home, but Tonya has repeatedly reacted with physical aggression toward her mother. The police have been called to their home on two occasions over the past 4 months, resulting in Tonya being admitted to inpatient psychiatric units for stabilization both times as an alternative to being taken into police custody.

Tonya feels that her mother does not respect her independence as an adult. She repeatedly shared that she would like to find independent living one day, and has been learning how to cook and clean on her own. Her mother believes that she will be able to care for herself independently, but worries about her ability to make decisions to keep herself safe. Kate recently began a relationship with boyfriend Mark, and Tonya has been upset about this. Tonya has yelled and thrown objects at Mark until Kate becomes so upset that she asks Mark to leave.

Tonya reportedly lived with her mother, stepfather, and stepsister Kayla from age 2 until her parents divorced last year. Both her stepfather and Kayla moved out-of-state when the divorce was finalized, and Tonya has not seen them since. Tonya does talk to Kayla and her stepfather weekly on the telephone and via text messaging.

Kate reported that Tonya has had difficulties regulating her emotions, particularly her anger, and this has gotten her fired from past jobs. Tonya dropped out of high school her senior year after she reportedly “didn’t feel like getting up and going to class anymore,” but would like to begin classes to obtain her GED and get a job so that she can live more independently. She was enrolled in some special education classes and had an Individualized Education Plan in place when she was attending school. She feels that she would not “fit in” working at a sheltered workshop with others with intellectual disabilities. Her mother reported that Tonya is “stuck in between not being high functioning enough and not being low functioning enough.”

While Tonya and Kate currently are having difficulties in their relationship, they are very supportive of each other. They enjoy going for walks in the park and visiting with Tonya’s maternal grandmother. Mother and daughter enjoy volunteering at a homeless shelter by serving meals on weekends. Tonya has recently been enjoying using her new cooking skills at the shelter.

Treatment Plan for Tonya The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Tonya.

C = Contextual Assessment Tonya is a 23-year-old biracial female. Her mother is Caucasian and her biological father is Latino and African American. Her stepfather and stepsister are also Caucasian, and Tonya does not have particular traditions or cultural practices related to her Latino and African American heritages. She developed mentally at a below normal rate, which physicians attributed to the fractured skull injury that she sustained at one week of age. She was enrolled in special education classes and had an IEP when she was enrolled in school. Tonya is struggling to gain more independence, which she feels that any 23-year-old woman should be able to have. Tonya believes that she is too high functioning to be put into a sheltered workshop or specialized living situation with other individuals with developmental disabilities, but struggles in mainstream work environments; primarily with social skills and emotion regulation.

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A = Assessment and Diagnosis Diagnosis = Intellectual Disability, Mild 317 (F70) Assessment = Prior documentation of intelligence testing was provided from the assessments related to Tonya’s IEP. The IQ score provided was 65.

N = Necessary Level of Care Outpatient individual counseling once every 1-2 weeks Family member involvement in sessions is recommended S = Strength-Based Lens Self: Tonya is a kind-hearted woman who enjoys volunteering. She desires independence, but is able to acknowledge that she has some limitations.

Family: She has a supportive family, and spends a great deal of time with her mother and grandmother engaging in healthy activities. Tonya enjoys learning new skills, such as cooking, and is motivated to earn her GED and obtain a job. While her stepfather and stepsister no longer live in the area, she maintains contact via telephone, and hopes to visit with them in the near future.

Community: She receives Social Security Disability benefits, which helps her to contribute to payments for food and her apartment she shares with her mother. She enjoys making friends and socializing.

T = Treatment Approach Behavior Therapy A = Aims and Objectives (3-month objectives) Tonya will have not demonstrate physical aggression physical aggression toward others when she is angry.

Tonya will have 0 incidences of using

Tonya will learn adaptive emotion regulation strategies and utilize these when she is experiencing negative emotions such as anger Tonya will use her learned emotion regulation strategies 70% of the time .

Tonya will receive social skills training Tonya will practice learned social skills and she will use 3 of these learned skills with others 80% of the time Tonya will develop and use a personal safety plan Tonya will develop and use her personal safety plan to be used in interpersonal relationships with others (i.e., romantic partners or those who try to take advantage of Tonya) and will apply this plan 100% of the time Tonya will learn how to more effectively link her thoughts with feelings and will verbally communicate her experiences to others Tonya will practice verbally sharing her positive or negative thoughts and emotions with her mother a minimum of 3 times per day.

R = Research-Based Interventions (based on Behavior Therapy) The counselor will help Tonya to: ● Acquire/enhance social skills ● Enhance feelings identification and expression ● Manage interpersonal relationships T = Therapeutic-Support Services ● Weekly individual counseling ● Referral to vocational services ● Referral to case management services

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Chapter 14 Case Study: Maria

By Cassandra Pusateri Ph.D., LPC (OH) Maria is a 66-year-old Hispanic female who as a young child emigrated with her parents from Mexico to the United States. She is proud of her cultural heritage and religiously identifies as a Catholic. At this time she isn’t involved in a faith community, but hopes to attend mass more in the future. Although Maria is currently unemployed, she volunteers weekly at a local community center. Maria has struggled to establish a social support network and her relationship with her husband and children is strained. However, she is quick to accept personal responsibility stating, “I know I have caused a lot of this.”

Maria was very close to her brother who committed suicide three years earlier. Over the past three years Maria has also attempted suicide, twice taking prescription medication and drinking alcohol. Each suicide attempt was followed hospitalization until she reached stability with a new medication plan. Although Maria has suicidal ideation daily, she reports no intention or plans to commit suicide and identifies her children and husband as her primary reason for wanting to live. Since her early childhood, Maria has had destructive thoughts and engaged self- injury inflicting superficial cuts on her arms. This has left Maria at times irritable and with intermittent feelings of worthlessness and hopelessness. She also reports that she has diminished motivation and for long periods of time ranging from two to three weeks, Maria says she finds no pleasure in her daily life.

Currently, she has several medical issues including high blood pressure, diabetes, and migraine headaches.

Maria has little recollection of certain life events that have occurred or even her age during these incidents. She relies on family members to provide her with this historical information. Maria reports being molested by her paternal uncle around the age of four. Maria told her mother about the molestation and her mother shamed Maria for lying. The molestation continued for approximately four years. Near the age of 12, an older man sexually assaulted Maria while she was walking home from school one day. Maria did not tell her parents about this event but did confide in her brother. Several years later, Maria fell in love, and married, her first husband around the age of 17. Maria’s first husband physically and emotionally abused her. It was during this marriage that Maria gave birth to her children. Shortly after her son’s birth, Maria’s husband admitted he was gay. According to Maria, everyone knew her husband was gay except Maria, and this made her feel like “an absolute fool.” Shortly thereafter, Maria and her first husband divorced. Two years later, Maria met and married her current husband.

Infidelity by both Maria and her second husband has contributed to a lack of trust and intimacy in their relationship, which Maria desires. Although Maria is interested in her husband sexually, she reports, “leaving her body” during sexual experiences. Additionally, Maria’s relationship with her children is strained. Although they speak frequently, Maria’s children resent her for many of the events that occurred during their childhood.

Maria acknowledges that while she met all of their physical needs she was emotionally unavailable. Maria’s daughter was sexually assaulted as a teenager and holds her mother personally responsible. Maria’s son resents her for taking him away from his biological father at an early age.

During the initial counseling session, Maria presented as herself. However, after two additional sessions, Maria’s alters started presenting themselves. Over the course of three counseling sessions, four alters were introduced. Maria is familiar with each alter however she does not remember any events or behaviors while the alters take possession of her body. The first alter is “Mary” who Maria describes as “the responsible one who takes care of everyone.” Then, there is “Isabella” who she describes as “the cheerful one who can make everyone laugh.” Isabella’s purpose is to lighten the mood when deep, emotional topics emerge. During the third counseling session, “Carlos” emerged when Maria began discussing a previous trauma. Carlos is described as “the protector who keeps scary people and things away.” Finally, when Maria was able to discuss a previous trauma, “Mimi” was introduced as “the weak one.” When Maria speaks about Mimi, she appears disgusted by her lack of strength and inability to protect herself. Mimi is approximately four years of age.

Treatment Plan for Maria The following I CAN START conceptual framework outlines treatment considerations that may be helpful when working with Maria.

C = Contextual Assessment Maria has a strong Hispanic cultural identity. She identifies religiously as a Catholic yet is currently not part of any faith community. As a child and an adult, Maria has a long history of sexual, physical, 42 © 2019 by Pearson Education, Inc. All rights reserved.

and emotional abuse and assaults perpetrated by males, and gender issues related to power differentials are important in understanding her circumstance. Currently, she is unemployed with no medical insurance. This places Maria in a lower socioeconomic class. She has a number of life stressors including a strained relationship with her husband and children and several medical concerns.

Developmentally, she struggles with autonomy, intimacy, and ego integrity.

A = Assessment and Diagnosis Diagnoses = Dissociative Identity Disorder 300.14 (F44.81); Posttraumatic Stress Disorder, Unspecified with dissociative symptoms 309.81 (F43.10); Major Depressive Disorder, Recurrent, Moderate 296.32 (F33.1) Assessments: A suicide risk assessment will be conducted at the beginning of each individual counseling session The Dissociative Experiences Scale (DES; Bernstein & Putman, 1986) will be used to fully assess for symptomology related to DID Previous medical assessments will be secured to rule out organic causes for Maria’s current symptomology N = Necessary Level of Care Outpatient, individual counseling (twice per week) Consideration for future family and marriage counseling based on Maria’s willingness and readiness Hospitalization may be necessary in the future due to increased risk of suicide and decreased stability S = Strength-Based Lens Self: Maria is a resilient survivor. Despite all of her life struggles, she seems determined and willing to succeed and overcome. She is a caring and giving person who remains active and volunteers weekly.

She is bright and appears motivated to attend and participate in the counseling process. She seems willing to work at developing a therapeutic relationship and move forward.

Family: Maria cares about her husband and her children and wants to be the best wife and mother she can be to support them. Family is important to her and she seems to garner a great deal of strength for her family relationships. While she has had some difficulties with her husband, she seems resolved to make the relationship work and he appears to be a supportive resource for her.

Community: She volunteers in the community and seems to have an active partnership with the local community center. She hopes to become more active in her Catholic community in the future.

T = Treatment Approach Phase-oriented approach with components of Dialectical Behavioral Therapy (DBT) and Cognitive Behavioral Therapy (CBT) A = Aim and Objectives of Treatment (3-month objectives) Establish Safety and Skills Training: Maria will utilize learned coping skills and not self- injure Maria will have 0 suicide attempts and reduce her incidents of self-injury to no more than 1 episode a week, and she will engage in appropriate wound care. She will utilize at least two DBT skills (i.e., mindful meditation, distress tolerance, emotional regulation, and interpersonal effectiveness) 100 % of the time when she has the urge to self-injure.

Maria will utilize mindful meditation skills and use these to help tolerate her negative thoughts Maria will apply at least one mindful meditation activity (e.g., living in the moment, experiencing emotions, observe non-judgmentally) two times a day when she is having destructive or judgmental thoughts.

Maria will decrease maladaptive thoughts Maria will utilize cognitive restructuring to examine her thoughts/beliefs, evidence review of the accuracy of these thoughts/beliefs, and engage in behavioral experimentation of more accurate thoughts/beliefs 80 % of the time.

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Seeking integration of traumatic memories and integrating multiple alters: Maria will increase communication and coordination between her alters identities Maria will, in sessions, discuss alternative identities and her trauma history as they represent adaptive attempts to cope with and/or master problems she faced/faces. Through the use of session, she will discuss and compare the alters in an attempt to increase the harmony of these identities by two increments on a 0-10 scale. For example: if she feels her alters are currently integrated with each other at around a level 2, then the treatment goal would be to increase to a level 5 by the 6 month time period.

R = Research-Based Interventions (based on DBT and CBT) Counselor will help Maria develop and apply the DBT following skills: ● Mindfulness skills ● Emotional regulation skills ● Distress tolerance skills ● Interpersonal effectiveness skills Counselor will assist Maria in organizing and integrating her memories of the trauma/ abuse.

Counselor will assist Maria in identifying cognitive distortions, discuss the effect of these distortions on her everyday functioning, and facilitate the restructuring of her cognitive processes using CBT techniques and interventions.

T = Therapeutic Support Services ● Medication evaluation with a psychiatrist ● Neurologist to assess sleep patterns and migraine headaches ● Medical appointments for high blood pressure and diabetes ● Weekly individual counseling ● Case management services

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Chapter 15 Case Study: Juan Juan is a 19-year-old Latino-American male with three sisters and a mother who was widowed before he was born. His culture, heritage and family are important to him and he is extremely close with his older sisters. Juan is a very bright, charismatic and personable young man who is in his first year of college studying civil engineering. Since early childhood, Juan has questioned and even challenged his own gender assignment.

As his mother reports, Juan started playing with dolls around the age of three and rejected any genderappropriate toys such as cars, balls, and trucks. In addition, Juan experimented with his mother’s clothing and jewelry and was always attracted to the cosmetics isle at stores. Most of Juan’s friends have been females. As a preschooler, Juan persistently asked his mother if he could wear dresses to church and to preschool. When he was six, Juan asked his mother “when [his] penis [would] disappear?” and he thought he would develop breasts when he entered puberty.

As an adolescent, Juan’s discomfort became more apparent when he couldn’t stand to look in a mirror, was reluctant to take a shower, and was perpetually self-conscious and aware of his gender. He states that he felt like “a woman trapped in a man’s body.” However, his mother was reluctant to allow him to dress as his desired gender due to religious reasons and fears that he would be bullied at school. One day after school, his mother found Juan sitting on the ledge of his bedroom window with the screen punched out. He told her that he needed to “become a girl in order to live.” He stated he could no longer stand to have his “penis” and that he needed to “get rid of it.”

Juan is profoundly unhappy with his assigned gender and desires to explore alternatives. He estimates that every moment of his life will be torture until he can become a woman. Last year, Juan was rushed to the hospital after overdosing on his mother’s prescription medication. Worried about her son’s life, Juan’s mother has reluctantly agreed to allow him to seek counseling and explore options for a “sex change.” His mother said she felt like she has “lost her son” and missed the opportunity to raise the “beautiful little [girl] she gave birth to.” She recently told Juan that all she wants is for him to be happy.

Juan describes the rest of his family as mostly unsupportive due to their “anti-gay” beliefs. He feels he has been “disowned by the most important people in his life.” He currently relies on the support of a close group of female friends and his aunt who unbeknownst to the family, identifies as “gay.” Also, Juan recently met Rafael, whom he has started to date. Rafael accepts him and is very supportive of the process Juan is going through. Although Juan feels extremely dysphoric most of the time, he is hopeful and optimistic that hormonal therapies and gender re-assignment surgeries can help him identify more fully as a woman.

Treatment Plan for Juan The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Juan.

C = Contextual Assessment Juan lives with his mother and three sisters. His father died before he was born and he has never had a father figure. Juan has a strong cultural heritage and places a high value on family. Developmentally, he struggles with his gender assignment. He is a biological male yet identifies and desires to be a female. This incongruence creates a great sense of dysphoria for Juan and complicates his interpersonal, school, and family relationships. He has had to deal with prejudices within society, within his cultural community, and within his own family. His social support system includes his mother, sisters, aunt, friends, and his boyfriend Rafael.

A = Assessment and Diagnosis Diagnosis = Gender Dysphoria 302.85 in Adolescents and Adults (F64.0) Assessment = Continuous evaluation of Juan’s readiness for hormonal and surgical treatments which include: (a) collecting the relevant history and development of Juan’s gender identity; (b) evaluation of other psychiatric diagnoses (if any are present); and (c) adherence to the World Professional Association for Transgender Health (WPATH) standards of care N = Necessary Level of Care Outpatient, individual counseling (once per week)

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S = Strength-Based Lens Self: Juan is an intelligent, engaging, and personable individual. His Latino-American, his cultural heritage and family are important to him. He is driven and motivated to be successful and is currently a student who is pursuing a degree in civil engineering.

Family: Although Juan lacks support from his extended family, Juan’s mother is supportive, loving, and a social support resource for him. Juan is extremely close with his older sisters and his aunt who are a strong support system for him.

Community: Although Juan feels discriminated against by his extended family, he has a number of supportive friends and is currently dating Rafael who is supportive and accepting. Juan has a strong cultural identity, yet feels alienated from his extended family and his cultural community.

T = Treatment Approach Supportive Counseling in conjunction with Real-Life Experiences (if Juan desires) A = Aim and Objective of Treatment (90-day objectives) Juan will process and explore his gender dysphoria and the conflicts that have undermined a stable lifestyle Juan will identify and process his thoughts/emotions around his assigned gender and his desired gender, family relationships, intimacy, and work/school-related issues that are undermining a stable lifestyle, in counseling and by journaling twice each week.

Juan will explore opportunities to live as his desired sex Juan will utilize real life experiences to explore his desired gender. Juan will identify and explore at least three consequences and three benefits of a real life experience and evaluate times to implement these real life experiences. Upon completion of his real life experiences, Juan will use a journal to record his thoughts, emotions, and overall reactions.

Juan will evaluate the advantages and disadvantages of hormonal and surgical therapies Juan will identify at least five benefits as well as five costs of pursuing hormonal and surgical procedures. He will discuss his findings in counseling sessions.

R = Research-Based Interventions (based on WPATH Standards of Care) Counselor can provide supportive therapy to help Juan navigate his feelings as he finds ways to live as a female in his current biological male body. The counselor will utilize unconditional positive regard and empathy to understand Juan’s new experiences living as the opposite sex.

Counselor can explore the use of real life experiences to provide Juan with time to explore the desired gender, processing the consequences (e.g., family, legal, vocational, interpersonal, economic) and ultimately making the process of passing easier if he continues to pursue gender reassignment.

Counselor can help Juan become informed and evaluate all of his available options (ranging from noninvasive to more invasive procedures).

T = Therapeutic Support Services ● Weekly individual counseling ● Medical consultation to exploration of the use of antiandrogen (which neutralize testosterone effect) or an LHRH agonist (which stop the production of testosterone) ● Medical consultation/evaluation to convey educational material about hormonal and gender reassignment options/procedures ● GD support groups

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Test Bank Questions Chapter 1: Developing Effective Treatment Plans Multiple-Choice Questions 1.

In general, which of the following variables have not been shown to affect treatment outcomes: a) The therapeutic relationship/alliance b) Counselor theoretical orientation c) Counselor training d) Counselor directiveness

2.

Which of the following is one of the most important client variables that determine successful counseling outcomes: a) Client’s motivation to change b) Client’s presenting concern c) Client’s social support d) Client’s personality

3.

According to the stages of change model, during the contemplation phase of change, the client: a) May lack awareness that a problem exists and have no intention of changing b) Is becoming more aware that a problem exists, but has made no plans to change c) Has begun planning small incremental changes, but has not begun this process d) Is implementing the action plan by modifying his or her behaviors

4.

Which of the following is the most important treatment variable that determines successful counseling outcomes? a) Duration of treatment b) The therapeutic alliance c) The treatment setting d) The cost of appointment

5.

A good treatment plan is relational. This means that a) It is tailored to the client’s individual needs and is based on client goals, objectives, and strengths. b) It focuses on client strengths, resources, times of resiliency, and ability to cope rather than the client’s diagnosis. c) It is sensitive to the client’s context of culture, gender, and other developmental factors. d) It is based on a strong client-counselor relationship, and is therefore sensitive to the client’s treatment goals and context.

6.

Guidelines for evaluating evidence-based treatments, theories, and/or approaches include all of the following, except: a) Approaches and interventions must be based on some documented, clear conceptual model of change b) Approaches and interventions must be similar to or found in federal registries and/or the peerreviewed literature c) Approaches and interventions are supported by the documentation of one scientific inquiry that seems credible and rigorous d) Approaches and interventions have been reviewed and deemed credible by informed experts in that treatment area

7.

In creating a treatment plan for clients, it is important that problem selection is a) Specific, concrete, and clearly stated b) General, concrete, and clearly stated c) Specific, abstract, and clearly stated d) General, abstract, and clearly stated

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8. Case conceptualization refers to a) developing a clinical picture of a client’s situation b) accurately diagnosing a client c) developing a treatment plan for the client d) understanding a client’s diagnosis 9. The I CAN START model is a) used mostly in children with autism to guide case conceptualization and treatment planning b) a model used by counselors to guide case conceptualization and treatment planning c) based on operant conditioning and used to motivate clients to meet treatment goals d) based on operant conditioning and used mostly in children to encourage progress 10. Treatment plans are developed a) mostly by the client b) mostly by the counselor c) by third party payers d) by the client, counselor, and treatment team (if applicable) 11. According to the DSM-5, in developing a treatment plan, the counselor can assess the client’s level of functioning through a) GAF (Global Assessment of Functioning) scores b) Solely counselor observations c) WHODAS scores d) GAF (Global Assessment of Functioning) and WHODAS scores 12. Counselors should assess a client’s level of functioning before creating a treatment plan in order to a) set realistic goals for the client b) determine if the client is suitable for psychosocial treatment c) determine which type of treatment would best fit the client’s needs d) determine the number of sessions in which to carry out the treatment plan 13. An appropriate treatment goal for a client with depression would be a) “The client will decrease her depression.” b) “The client will occasionally exercise, get adequate rest, eat healthy foods, and will use positive self- talk 75% of the time.” c) “The client will use positive self-talk.” d) “The client will learn and use positive self-talk to engage with family members in the home 50% of the time.”

14. According to the SMART acronym, treatment goals should be a) Specific, measurable, attainable, reasonable, and timely b) Specific, measurable, attainable, results-oriented, and timely c) Simple, measurable, attainable, reasonable, and timely d) Simple, measurable, attainable, results-oriented, and timely 15. Although there is software available that outputs client treatment plans, it is important that counselors a) Ensure the treatment plan is specific to client needs b) Not deviate from the treatment plan outputted by the software c) Ensure that the treatment plan is correct as the software is often inaccurate d) Use the same treatment plan for each client with a given diagnosis 16. Which of the following is a reason for using formal assessment in developing treatment plans: a) It helps counselors to better understand the client b) It allows clients to play an active role in treatment planning c) It determines if the client is at risk of harming self or others d) It provides statistical validity for the treatment plan 17. Which of the following is true of treatment plans: a) They are static documents that should not be changed b) They are fluid documents that must continuously be adjusted

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c) They are created mostly by the client d) They are created mostly by the counselor 18. Client progress is measured mostly through a) Personality assessments b) Client self-report c) Interviewing d) Counselor observations 19. Using the I CAN START model, treatment planning is mostly focused on a) Changing the client’s automatic thoughts b) Improving the client’s weaknesses c) Integrating the client’s strengths d) Understanding a client’s context 20. Therapeutic support services are used to a) Assist counselors in treating clients with multiple diagnoses, especially severe disorders such as schizophrenia b) Allow counselors to connect with other counselors in a group setting to promote self-care and prevent burn-out c) Provide clients the opportunity to connect with others who are experiencing similar issues in an informal group setting d) Provide clients with additional support beyond psychosocial therapy through education, training, socialization, and navigation of difficult processes 21. It is important that clients choose their own treatment goals primarily so that they a) will be motivated to change b) do not feel dominated by the counselor c) feel they have power in the relationship d) can develop their own treatment plans 22. Camille has been seeing you for one month now. At the beginning of treatment, she stated that she wanted to improve her self-esteem and learn how to make friends. Together, you developed a six-week treatment plan to work on these issues. However, today Camille reveals to you that her younger sister was raped and Camille is having trouble processing the event. You should: a) Finish the two weeks of treatment and then develop a separate treatment plan to process her sister’s rape b) Use the first counseling session to process the traumatic event, then continue with the original treatment plan c) Process the traumatic event for as long as Camille feels necessary, then continue with the original treatment plan d) Contact Camille’s mother and suggest that Camille’s sister attend psychosocial therapy 23. Two important variables counselors must balance in treatment planning include a) client’s commitment to treatment and client’s situation/preferences b) client’s willingness to change and client’s situation/preferences c) client’s willingness to change and evidence-based treatments d) client’s situation/preferences and evidence-based treatments 24. A common mistake made by novice counselors in creating treatment goals is a) Creating too many treatment goals or goals that are too complex b) Creating too few treatment goals or goals that are too simple c) Creating treatment goals themselves instead of allowing the client to create them d) Creating goals that are too easy for the client to accomplish 25. According to the I CAN START model, contextual assessment refers to a) Observations the counselor makes in the context of treatment b) Other issues the client is facing surrounding the primary diagnosis c) Factors such as demographics, family dynamics/support, and current struggles d) Using formal and informal assessment to aid in case conceptualization 49 © 2019 by Pearson Education, Inc. All rights reserved.

26. A good treatment plan should be a) Collaborative, specific to client needs, and based on a timetable b) Collaborative, general in nature, and based on a timetable c) Based solely on counselor expertise, specific to client needs, and based on cognitive behavioral therapy d) Created solely by the client, specific to client needs, and based on a timetable

Essay Question 1.

List out the components of the I CAN START conceptual framework and briefly describe the importance of each factor in treatment.

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Chapter 2: Real World Treatment Planning: Systems, Culture, and Ethics Multiple-Choice Questions 1.

One result of the increase in managed care systems is: a) Increased client confidentiality b) Decreased client confidentiality c) Increased record keeping for counselors d) Decreased record keeping for counselors

2.

Many counselors to avoid ascribing clients with stigmatizing diagnoses, while others to ensure clients’ services are covered. a) Downcode; upcode b) Upcode; downcode c) Downgrade; upgrade d) Upgrade; downgrade

3.

Third Party payers are most likely to cover the costs of treatment for which of the following disorders: a) Personality disorders b) Other conditions that may be a focus of clinical attention c) Autism spectrum disorders d) Major depressive disorder

4.

Accrediting bodies’ function is to a) Ensure that counselors provide the most accurate diagnosis possible b) Ensure that all clients receive services, regardless of the severity of their problem c) Ensure that clients are able to attain treatment for as long as necessary d) Enhance the quality of services provided to consumers of services

5. The client’s is typically used by third party payers to determine the number of sessions and type of counseling that is approved for reimbursement a) Income level b) Diagnosis c) Treatment plan d) Presenting issue 6.

Third party payers generally reimburse clients for they receive a) More b) The same amount of c) Fewer d) It is dependent on client income level

services than/that counselors would recommend

7. Counseling session limits influence a) Treatment plan and goals b) Treatment goals c) Treatment plan d) Diagnosis 8. Oftentimes, a is the treatment leader in treatment teams. a) Office Manager b) Supervisor c) Physician/psychiatrist d) Community psychiatrist support provider 9.

All of the following are concerns of the DSM, except: a) Historically, some diagnostic labels have been marginalized and stigmatized b) There is limited evidence of cross-cultural validity in diagnostic conceptualizations 51 © 2019 by Pearson Education, Inc. All rights reserved.

c) The DSM can predict treatment outcomes d) There are flaws in the science behind DSM diagnoses 10. A medical model of change places the responsibility for problems—and for change—at/on the level. a) Relational b) Individual c) Community d) Societal 11. The is a positive development in the DSM-5 that helps counselors obtain the most clinically useful information, develop a relational connection with clients, and ultimately make accurate diagnoses. a) Cultural formation interview b) Global assessment of functioning scale c) Cultural diversity assessment d) Developmental formation interview 12. The primary purpose of informed consent is to a) Assess the client’s readiness for counseling b) Establish rapport between the client and counselor c) Ensure that the client fully understands the counseling process d) Outline the counselor’s fee schedule 13. The most recent version of the American Counseling Association’s (ACA) Code of Ethics was published in what year? a) 2004 b) 2010 c) 2018 d) 2014 14. Ethical standards require that counselors provide a) Accurate; severe b) Definitive; misrepresenting c) Accurate; misrepresenting d) Accurate; chronic

diagnoses as well as avoid

diagnoses.

15. Which statement is false regarding multiple relationships? a) Sexual and/or romantic counselor-client interactions or relationships with current clients, their romantic partners, or their family members are prohibited by current ethical standards b) Counselors must consider ways they can manage the therapeutic-fiduciary relationship c) A client may be harmed if a counselor engages in a multiple relationship with him/her d) Only sexual and/or romantic counselor-client interactions or relationships with current clients is prohibited by current ethical standards 16. Consultation and supervision can help counselors a) Ensure that diagnostic and treatment planning procedures are consistent with typical standards of care b) Decide how to best prevent harm to the client c) Ensure that an accurate diagnosis is ascribed d) All of the above 17. A culturally sensitive assessment is not achieved if a) A counselor assessed the client’s presenting issue solely from her/his clinical lens b) A counselor assessed the effect of trauma c) A counselor assessed gender socialization d) A counselor assessed cultural identity and values

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18. Cultural validity in assessment requires that mental health professionals consider specific cultural backgrounds and norms such as a) socioeconomic status b) functional abilities c) race/ethnicity d) All of the above 19. Which statement reflects a counselor skill for diversity-sensitive diagnosis and treatment a) Know and use only symptom scales validated in the client’s culture b) Commit to assessing and overcoming personal biases and stereotypes c) Conduct gender-sensitive clinical assessments d) Avoid jumping to conclusions about clients on the basis of their cultural group 20. Which is true about informed consent? a) Informed consent is a one-time event that occurs on the first day of counseling b) Informed consent needs to be revisited in counseling only during ethical issues c) Informed consent does not include informing clients about changes in diagnosis d) Informed consent is an ongoing process

Essay Questions: 1.

What are at least three strengths of the DSM/medical model? What are at least three weaknesses of the DSM/medical model?

2.

Describe four strategies counselors can use to facilitate ethical diagnoses and treatment practices.

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Chapter 3: Safety-Related Clinical Issues and Treatment Planning Multiple-Choice Questions 1.

Potential indicators for suicide include all of the following, except: a) Frequent crying spells b) Past suicide attempts c) Substance abuse d) Presence of a mental health disorder

2.

Counselors should be aware of suicide ideation among individuals with which of the following disorders? a) Depression b) Bipolar disorders c) Individuals with multiple diagnoses d) All disorders

3.

Which of the following are core competencies necessary for counseling suicidal clients? a) Risk assessment and intervention skills, developing an effective crisis plan, understanding associated legal and ethical issues, and accurate documentation b) Risk assessment and intervention skills, understanding the various types of suicide, encouragement, and accurate documentation c) Risk assessment and intervention skills, understanding the various types of suicide, understanding associated legal and ethical issues, and accurate documentation d) Risk assessment and intervention skills, developing an effective crisis plan, encouragement, and accurate documentation

4.

It is possible that in assessing for suicide risk, counselors will encounter false positives or false negatives. An example of a false negative would be a) providing restrictive levels of care to clients not seriously in danger of killing themselves b) failing to have hospitalized clients who go on to commit suicide c) providing restrictive levels of care to clients who are at risk for suicide d) failing to have hospitalized clients who are not at risk for suicide

5.

It is recommended that counselors working with suicidal clients a) Do not introduce the topic of suicide unless the client does first b) Help the client realize that there are others who are worse off than they are c) Engage in peer consultation and obtain supervision d) Give clients their cell phone numbers in case of emergency

6.

The following is an especially strong predictor of future suicide attempts a) Thoughts of hopelessness b) Past suicide attempts c) Depression d) Giving away one’s possessions

7.

A counselor’s number one priority should be a) Establishing a therapeutic alliance b) Accurate diagnosis c) Demonstrating empathy d) Client safety

8.

A counselor may establish a contract for safety for suicidal clients. This contract states that a) The counselor will not be sued if a client commits suicide b) The client will not commit suicide for a specific period of time c) The client’s caregivers will maintain vigilance of the client for a specific period of time d) The client will contact the counselor if tempted to commit suicide

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9.

In treating suicidal clients, it is most helpful when counselors a) Help clients overcome their weaknesses b) Determine clients’ motivations for wanting to commit suicide c) Emphasize client strengths to promote self-esteem d) Remind clients how much their family would miss them if they committed suicide

10. Which of the following is a counselor consideration for clients with suicide ideation? a) Maintaining a calm demeanor and using neutral body language b) Maintaining a sense of collaboration in treatment c) Understanding potential legal and ethical issues in the treatment of interpersonal violence victims d) Establishing rapport and providing a safe and comfortable environment 11. In treating clients with homicidal ideation, it is especially important that counselors maintain a(n) demeanor, while using neutral body language. a) Serious and calm b) cordial and nonjudgmental c) nonjudgmental and calm d) calm and cordial 12. Which of the following factors are associated with homicidal ideation? a) Past criminal charges, lack of empathy and remorse, psychiatric disorders, and substance abuse b) Past criminal charges, lack of empathy and remorse, poor familial relationships, and substance abuse c) Past criminal charges, lack of empathy and remorse, psychiatric disorders, and low self-esteem d) Past criminal charges, lack of empathy and remorse, low self-esteem, and substance abuse 13. In assessing homicidal clients, counselors should a) Ask general, indirect questions to avoid angering the client b) Ask specific, direct questions about the client’s plan and means of accomplishing it c) Determine the client’s likelihood of committing homicide through heuristics d) Determine the client’s likelihood of committing homicide through demographics and counselor observations 14. Effective interventions for homicidal clients a) Have been clearly established b) Are unique for each client c) Have not yet been tested d) Have not been shown to be effective 15. If a counselor learns of a homicidal client’s intended victim, the counselor should a) Notify the intended victim b) Anonymously notify the police, but not the intended victim c) Notify the intended victim only if the threat seems serious d) Never breach confidentiality 16. Which of the following are risk factors for interpersonal violence victims? a) Being young, unemployed, of low socioeconomic status, and having low self-esteem b) Being young, of African American descent, of low socioeconomic status, and having low selfesteem c) Being young, of Asian American descent, of low socioeconomic status, and having low selfesteem d) Being young, attractive, of low socioeconomic status, and having low self-esteem 17. Which of the following is a counselor consideration for interpersonal violence victims? a) Maintaining a calm demeanor and using neutral body language b) Maintaining a sense of collaboration in treatment c) Understanding potential legal and ethical issues in the treatment of interpersonal violence victims d) Establishing rapport and providing a safe and comfortable environment

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18. The most common psychiatric disorder among interpersonal violence victims is a) Depression b) Generalized anxiety disorder c) Multiple personality disorder d) Posttraumatic stress disorder 19. One important aspect of treating interpersonal violence victims is a) Suicide prevention b) Psychoeducation c) Couples counseling d) Existential therapy 20. Counselors may help interpersonal violence victims construct a and work with clients to improve self-esteem. a) Safety inventory b) Safety contract c) Safety plan d) Self-protection plan

to manage violent situations

Essay Questions: 1.

What are at least five safety plan considerations for working with people in violent relationships?

2.

Discuss 5-7 protective factors of homicide risk that counselor should consider when conducting an assessment for homicidal ideation.

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Chapter 4: Depressive, Bipolar, and Related Disorders Multiple-Choice Questions 1. Depressive and bipolar disorders impact a) 15 b) 35 c) 20 d) 2-10 2.

percent of the general population:

is the language used in the DSM-5 to classify depressive and bipolar disorders. a) b) c) d)

Symptoms Episodes Mood Diagnosis

3. A client presents in a manic episode and has a history of a single major depressive episode.

Which diagnosis would most likely be given? a) Bipolar II b) Major depressive disorder c) Bipolar I d) Cylcothymia 4. An elevated risk of suicide is a significant consideration with which disorders? a) Premenstrual dysphoric disorder and major depressive disorder b) Major depressive disorder, bipolar I and bipolar II disorders c) Bipolar I and bipolar II disorders and cyclothymia d) Mood dysregulation disorder and Bipolar I disorder 5. Which of the following are important considerations in treating individuals with depressive and bipolar disorders? a) Symptom management, relapse prevention, and adaptive functioning b) Exercise, relationship forming, and medication management c) Symptom management, exercise, and medication management d) Relapse prevention, adaptive functioning, and medication management 6. Adjunct therapies to be considered in the treatment of major depressive disorder include: a) Mindfulness based interventions and electroconvulsive therapy b) Electroconvulsive therapy and cognitive behavioral therapy c) Cognitive behavioral therapy and mindfulness based interventions d) Cognitive behavioral therapy and behavioral activation therapy 7. A child with disruptive mood dysregulation disorder may present with which of the following constellation of symptoms: a) Mood swings, irritability, and tantrums b) Persistent sadness, fatigue, and suicidal ideation c) Hypomania, agitation, and irritability d) Delusions, violent behavior, and mania 8. Greg presents as down in the dumps, tends to assume the worst and complains of insomnia.

Which of these disorders most closely matches these symptoms? a) Major depressive disorder b) Bipolar II disorder c) Persistent depressive disorder d) Disruptive mood dysregulation disorder

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9. Which of the following therapeutic approaches may be considered an effective approach for the treatment of premenstrual dysphoric disorder? a) Interpersonal and social rhythm therapy b) Cognitive behavioral therapy c) Family focused therapy d) Problem solving skills training 10. When assessing possible risks for Jane who has been diagnosed with persistent depressive disorder, which of the following should be considered: a) Occurrence of symptoms during menstruation and emotional and physical abuse b) Marital dissatisfaction and occurrence of symptoms during menstruation c) Emotional and physical abuse and marital dissatisfaction d) Overall cognitive functioning and emotional and physical abuse 11. During a manic episode, an individual may experience: a) Euphoria, decreased need for sleep, and grandiosity b) Depression, increased need for sleep, and increased suicide risk c) Euphoria, decreased need for sleep, and increased suicide risk d) Euphoria, increased need for sleep, and inability to concentrate 12. is the most commonly occurring subtype within the umbrella of Bipolar Disorders: a) Bipolar I b) Bipolar II c) Cyclothymic disorder d) Premenstrual dysphoric disorder 13. A counselor using cognitive-behavioral therapy to treat a client with major depressive disorder might have as his/her main treatment goal: a) Teaching clients to monitor their affect and activity each day b) Externalizing the problem by defining depression as a treatable medical illness c) Offering positive reinforcement for engagement in pleasurable activities d) Teaching clients to recognize and manage their reactions to depressive symptoms 14. Counselors who work with individuals with Bipolar I should seek personal support because: a) Counselors always consult with others for every case b) Those with Bipolar I have a high rate of suicide c) The state requires counselors to do so d) This is stated in the ACA Code of Ethics 15. The STEP form of treatment is the: a) Systematic Time Elapsed Program b) Systems Treatment Entirety Program c) Systematic Treatment Enhancement Program d) Systemic Triage Enhancement Program 16. Because of potential risk, there has been limited pharmaceutical research for those with Bipolar II in the following population: a) Military personnel b) Nineteen-year-old individuals c) Pregnant women d) Elderly males 17. Family Focused Therapy (FFT) is devised into three modules: a) Group therapy, problem-solving, and medication b) Psychoeducation, communication, and problem-solving c) Psychoeducation, family meetings, and communication d) Family meetings, active listening, and psychoeducation

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18. Electroconvulsive therapy (ECT) or electroshock therapy as a form of treatment for Bipolar I is: a) Used with individuals who are suicidal b) Used with individuals who are slightly depressed c) Used to treat symptoms of manic episodes d) Used with individuals who are suicidal and have limited success with psychopharmacology 19. Individuals with Bipolar II_ a) Always b) Never c) Sometimes d) Annually

experience psychotic symptoms and are more likely to be females.

20. One of the warning signs of a person entering a phase is that there is a remarkable, directly noticeable sudden change in functioning that is uncharacteristic of the individual. a) Manic phase b) Depressive phase c) Hypomanic phase d) Cyclothymic

Essay Questions Sophie is a 30-year-old Polish American female who presents to counseling with her husband. For the past six days, Sophie has not slept at all. She has gone around the house in a busy state, but has started many projects only to leave them completely undone. She began talking to her husband about the idea that she is a new business owner who is starting a fashion design center though she has never had any experience in this realm as she studied anthropology in college and has been a stay at home mother to their only son, a 7-year-boy. Sophie is usually an organized person who keeps lists, but this past week the lists have been excessive and have not made sense and are now cluttering up every room in the house.

Sophie has experienced an episode of disorganized behavior followed by a period of depression. While in the depressed state, she was unable to talk with friends, attend classes, or eat properly. During this time, Sophie even considered suicide as an option. Sophie’s mother had episodes of depression as Sophie was growing up, so when Sophie’s roommate contacted her mother during this time, Sophie was told that this was simply a part of life. At the present time, Sophie doesn’t feel she needs counseling, but with her husband’s insistence she has come to your office.

Essay Question 1: What diagnosis would you give Sophie and why? Please provide a one to two paragraph explanation for the diagnostic criteria you believe is being met in the case study. Please be specific and clear when describing the diagnosis and any supporting evidence.

Essay Question 2: Create a treatment plan for Sophie (I CAN START). Please ensure you include the following components: (1) Two to three goals for the therapeutic process (2) One to two measurable objectives for each goal (3) One to two interventions to be used by the counselor to assist with the achievement of the measurable objectives and ultimately the goals

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Chapter 5: Anxiety Disorders Multiple Choice Questions 1.

The following factors are necessary for the diagnosis of an anxiety disorder: a) a disruption in one’s ability to function b) physiological sensations (e.g., tightness of chest, shortness of breath, etc.) c) psychological states (e.g., apprehension, fear, etc.) d) physiological and psychological states

2.

To best assist a client with an anxiety disorder, a counselor should a) tackle the causes of the problem first, then work to relieve symptoms b) focus on relieving symptoms first, then tackle the causes of the problem c) avoid the clients’ presenting problem, and work on other issues first to develop rapport d) talk about the weather

3.

What differentiates an individual with panic disorder (PD) from those enduring occasional panic attacks? a) Anticipatory anxiety of future panic attacks b) Having a panic attack at least twice per month c) Catastrophic thoughts during a panic attack and anticipatory anxiety of future panic attacks d) Catastrophic thoughts during a panic attack and having a panic attack at least twice per month

4.

Panic disorder is often not diagnosed right away because a) clients mistaken it for physical ailments b) clients are embarrassed to come to treatment c) clients fear talking about it will trigger another panic attack d) clinicians misdiagnosis it for other anxiety disorders

5.

Specific phobias are most common among which group: a) the elderly b) children c) men d) women

6.

The best prognosis for specific phobias occurs with: a) Cognitive behavioral therapy b) Acceptance and commitment therapy c) Exposure therapy d) Dialectical behavior therapy

7.

Which of the following is the most evidence-based treatment for agoraphobia? a) Imaginal exposure b) Situational in vivo exposure c) Relaxation training d) Cognitive-behavioral therapy

8.

The hallmark of social anxiety disorder is: a) a fear of positive evaluation in social situations b) a fear of negative evaluation in social situations c) a fear of offending someone in a social situation d) a fear of having a panic attack in a social situation

9.

Which of the following disorders has the lowest comorbidity rate? a) Panic disorder b) Social anxiety disorder c) Specific phobia d) Generalized anxiety disorder

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10. The Intolerance of Uncertainty Model (IUM) states that individuals with generalized anxiety disorder: a) have increased anxiety because of their inability to tolerate uncertainty b) avoid uncertain situations in an attempt to reduce anxiety c) believe that worry protects them from negative events or prepares them to cope d) have more difficulty coping with life than the average person 11. Anxiety disorders have a(n): a) High recovery rate and high relapse rate b) Low recovery rate and low relapse rate c) High recovery rate and low relapse rate d) Unknown prognosis 12. Acceptance and commitment therapy: a) Focuses on accepting the past and committing to a better future b) Encourages clients to accept rather than attempt to control passing thoughts c) Allows clients to face their fears according to a hierarchy d) Involves restructuring irrational thoughts that lead to anxiety 13. Which of the following is a potential contributor to separation anxiety disorder? a) Parental over-control b) Poor sibling relationships c) Parental drug abuse d) Poor peer relationships 14. Agoraphobia refers to the fear of: a) Going out in public b) Heights c) Situations in which escape may be difficult or impossible d) Spiders 15. Which of the following are most commonly prescribed to treat generalized anxiety disorder? a) Anxiolytics and SSRI’s b) Benzodiazepines and SSRI’s c) Anxiolytics and SNRI’s d) Benzodiazepines and lithium 16. Which of the following best describes situational in-vivo exposure treatment? a) a process by which a client confronts fears by imagining confronting feared situations and stimuli b) a process by which a client gradually exposures herself to a feared situation by entering a remaining in the situation until anxiety diminishes. c) a process by which a client learns to confront irrational and catastrophic cognitions during exposure therapy d) a process by which a client exposes herself to a feared situation through the process of flooding, or immediately exposing herself to the most anxiety-provoking situation on a hierarchy 17. Selective mutism generally occurs before the age of: a) 5 b) 10 c) 15 d) 20 18. One commonly used treatment for selective mutism is: a) Psychodynamic psychotherapy b) Family interventions c) Music therapy d) Social skills training

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Essay Questions 1.

Describe three important counselor considerations in treating clients with an anxiety disorder.

2.

Discuss three established treatments for social anxiety disorder.

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Chapter 6: Obsessive-Compulsive and Related Disorders Multiple-Choice Questions 1.

Which of the following is true of anxiety-related disorders? a) They tend to overlap and exist comorbidly with one another b) They are very difficult to treat and client progress is often slow c) They usually manifest before the age of five d) They are the least common category of disorders

2.

In treating anxiety disorders, counselors should assess clients’ commitment to treatment in order to a) Ensure clients are good candidates for psychosocial therapy before creating a treatment plan b) Motivate clients to reach their treatment goals and become committed to treatment c) Avoid premature treatment termination as clients may be reluctant to change d) Allow clients to gain insight into their disorder to improve treatment outcomes

3.

The main factor motivating anxiety disorders is that the obsessions a) Relieve the client of distressing feelings b) Feed the client’s perfectionistic tendencies c) Give the client a sense of power d) Relieve the client’s subconscious desires

4.

Which of the following disorders is most likely to occur with obsessive compulsive disorder (OCD): a) Bipolar disorders b) Depression c) Schizophrenia d) Multiple personality disorder

5.

Which of the following is a counselor consideration for treating clients with OCD? a) Counselors should frequently reassure clients that treatment can improve their quality of life b) Counselors must ensure that the client’s symptoms are not better accounted for by a different diagnosis c) Counselors should be patient as clients may become defensive or deny their behavior d) Counselors should be mindful that clients will likely be hypersensitive to criticism

6.

Which of the following is an evidence-based treatment for OCD? a) Rational-emotive therapy b) Existential therapy c) Mindfulness-based treatments d) Adlerian therapy

7.

Which of the following is a counselor consideration for treating clients with hoarding disorder (HD)? a) Counselors should frequently reassure clients that treatment can increase their quality of life b) Counselors must ensure that the client’s symptoms are not better accounted for by a different diagnosis c) Counselors should be patient as clients may become defensive or deny their behavior d) Counselors should be mindful that clients will likely be hypersensitive to criticism

8.

Which of the following is a counselor consideration for treating clients with body dysmorphic disorder? a) Counselors should frequently reassure clients that treatment can increase their quality of life b) Counselors must ensure that the client’s symptoms are not better accounted for by a different diagnosis c) Counselors should be patient as clients may become defensive or deny their behavior d) Counselors should be mindful that clients will likely be hypersensitive to criticism

9.

A biopsychosocial model is used in treating which of the following disorders? a) Hoarding disorder b) Obsessive-compulsive disorder

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c) Body dysmorphic disorder d) Trichotillomania (hair pulling) 10. It is particularly important that counselors provide social support for clients with a) Hoarding disorder b) Obsessive-compulsive disorder c) Body dysmorphic disorder d) Trichotillomania 11. Inference-based therapy is a commonly used treatment for which of the following disorders a) Body dysmorphic disorder b) Trichotillomania c) Hoarding disorder d) Excoriation (skin picking) disorder 12. Clients with often feel alienated and misunderstood by family, friends, and/or significant others. a) Hoarding disorder b) Obsessive-compulsive disorder c) Trichotillomania d) Body dysmorphic disorder 13. The following treatment objectives: increasing clients’ awareness of their behaviors, developing a competing response for their picking behaviors, creating a contingency management system, and generalizing their new behaviors to alternative situations, are part of which of the following trichotillomania interventions: a) Acceptance and commitment therapy b) Cognitive-behavioral therapy c) Exposure-based interventions d) Habit reversal training 14. Clients with may be hostile toward the counselor, self-conscious, and embarrassed by their perceived imperfections a) Obsessive-compulsive disorder b) Body dysmorphic disorder c) Excoriation disorder d) Trichotillomania 15. Which of the following medications have been found to be particularly helpful for clients with HD: a) Prozac b) Lithium c) SSRI’s d) Medication has not been found to be effective 16. The most effective intervention for OCD is: a) Exposure therapy b) Habit reversal training c) DBT d) CBT 17. Group CBT is effective in treating: a) Hoarding disorder b) Obsessive-compulsive disorder c) Trichotillomania d) Body dysmorphic disorder 18. Stimulus control (SC) and dialectical behavior therapy (DBT) have been shown to be effective for clients with a) Body dysmorphic disorder b) Trichotillomania

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c) Hoarding disorder d) Excoriation (skin picking) disorder 19. a) b) c) d)

was newly added to the DSM-5.

Hoarding disorder Trichotillomania Excoriation disorder Body dysmorphic disorder

20. Individuals with often feel powerless and unable to control their behaviors. a) Excoriation disorder b) Hoarding disorder c) Body dysmorphic disorder d) Generalized anxiety disorder

Essay Questions 1.

Identify each of the four components of the circular cycle of obsessions and compulsions. Briefly describe each of the components in 1-3 sentences.

2.

How might community support be utilized by a counselor who is working with a client diagnosed with hoarding disorder?

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Chapter 7: Trauma- and Stressor-Related Disorders Multiple Choice Questions 1.

The following factors are key in establishing a therapeutic alliance with trauma victims: a) Patience and trust b) Patience and unconditional positive regard c) Trust and unconditional positive regard d) Trust and respect

2.

Self-care is especially important in working with trauma victims because of a) Burnout and vicarious sensitization b) Burnout and vicarious trauma c) Burnout and secondary trauma d) Burnout and trauma sensitization

3.

The severity and duration of trauma symptoms depends greatly on a) The duration of the traumatic experience b) The type of traumatic experience c) The individual’s tolerance level d) The individual’s reaction

4.

Which of the following is a common characteristic of children with attachment disorders? a) Insomnia b) Depression c) Hypervigilance d) Low-self esteem

5.

Before diagnosing an attachment disorder, it is important that counselors explore play a role in the child’s attachment style. a) Personality traits b) Cultural factors c) Family dynamics d) Biological factors

6.

In treating clients with any trauma or stress-induced disorder, it is imperative to first assess for a) Low self-esteem b) Personality disorders c) Current addictions d) Ongoing abuse

7.

Because there are no research-based, universal assessments for attachment disorders, counselors often use a approach. a) Differential b) Multivariate c) Multimodal d) Diverse

8.

The difference between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) is that: a) ASD occurs within 4 weeks of the event and lasts between 2 days and 4 weeks, while PTSD can occur later and is longer lasting b) PTSD occurs within 4 weeks of the event and lasts between 2 days and 4 weeks, while ASD can occur later and is longer lasting c) ASD involves exposure to events that are considered less traumatic than those necessary to qualify for PTSD d) ASD involves more severe symptoms than PTSD

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that may

9.

Seven months ago, Josh witnessed a movie theater shooting. Although he escaped unharmed, Josh claims he started experiencing anxiety, hypervigilance, and intrusive thoughts about the event, and is having difficulty sleeping. He has not been able to enter a movie theater since the attack. Josh also specifies that the symptoms have recently come about within the last month. Josh’s symptoms might meet the diagnostic criteria for a) Acute stress disorder (ASD) b) Posttraumautic stress disorder (PTSD) c) PTSD With Delayed Onset d) ASD With Delayed Onset

10. Because ASD and PTSD often occur in conjunction with other disorders, it is essential that counselors a) Treat all diagnoses simultaneously b) Provide differential treatment c) Provide accurate diagnosis d) Assess for differential comorbidity 11. Which of the following is a commonly used treatment for ASD and PTSD? a) Prolonged exposure therapy b) Acceptance and commitment therapy c) Dialectical behavior therapy d) Interpersonal psychotherapy 12. Attachment disorders result from a) Difficulties in peer/sibling relationships b) Childhood sexual abuse or rape c) Parental neglect and maltreatment d) Overly protective and affectionate parenting 13. A key determinant in the prognosis of attachment disorders is a) The child’s developmental level and social functioning b) The child’s attitude toward his/her caregivers c) Treating the root of the problem first, then addressing the disorder d) Diagnosing and treating the disorder as early as possible 14. A child who forms inappropriate attachments to strangers and displays other socially inappropriate behavior might be diagnosed with a) Pervasive developmental attachment disorder b) Disinhibited social engagement disorder c) Social dysregulation attachment disorder d) Reactive attachment disorder 15. In order to be diagnosed with an adjustment disorder, a client must experience a) symptoms of the disorder for at least 6 months b) multiple life stressors simultaneously c) a disproportionate reaction to a life stressor d) a disproportionate reaction to multiple life stressors 16. Which of the following treatments for adjustment disorders focuses on one issue agreed upon by the counselor and client: a) Interpersonal psychotherapy b) Brief psychodynamic psychotherapy c) Solution-focused brief therapy d) Brief cognitive-behavioral therapy 17. Although the prognosis for adjustment disorders is favorable, children are future mental disorders as compared to adults. a) Less likely b) More likely c) Just as likely d) Children cannot be diagnosed with adjustment disorders 67 © 2019 by Pearson Education, Inc. All rights reserved.

to development

18. In treating adjustment disorders, counselors must be especially mindful of a) Client’s history of substance abuse b) Length of time the disorder has occurred c) The precipitating event causing the disorder d) Cultural factors and client background 19. In clients with adjustment disorders, suicide risk is and/but there is as compared to major depressive disorder. a) Increased; a shorter time between initial suicide ideation and suicide completion b) Increased; a longer time between initial suicide ideation and suicide completion c) Decreased; a longer time between initial suicide ideation and suicide completion d) Decreased; a shorter time between initial suicide ideation and suicide completion 20. Because adjustment disorders are time-limited diagnoses, to treat people who have these disorders, counselors often use a) Solution focused brief therapy and brief psychodynamic psychotherapy b) Solution focused brief therapy and brief humanistic therapy c) Brief humanistic therapy and brief psychodynamic psychotherapy d) Brief gestalt therapy and brief cognitive-behavioral therapy

Essay Questions 1.

Dyadic developmental psychotherapy is one empirically supported approach for treating clients with attachment disorder and complex trauma experiences. Briefly describe the essential features of this approach.

2.

Do you believe that concepts of developmental trauma, complex trauma, or complex trauma disorder should be included in the DSM? Why or why not?

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Chapter 8: Substance-Related and Addictive Disorders Multiple-Choice Questions 1.

An individual with gambling disorder would most likely have a) Bipolar I disorder b) Obsessive-compulsive disorder c) Depression d) Borderline personality disorder

as a comorbid diagnosis.

2.

Many in treatment for which category of disorders have suicide ideation: a) Alcohol-related disorders b) Gambling disorders c) Opioid-related disorders d) Inhalant-related disorders

3.

Which of the following best describes family therapy for drug-related disorders: a) An approach used to treat the dysfunctional systems which allowed the disorder to develop b) An approach used to garner support for the individual and his/her treatment process c) An approach in which family members continuously monitor the individual to prevent drug abuse d) An approach in which family members receive individual counseling to cope with the abuse

4.

In treating clients with substance use disorders, counselors should expect clients to have a) No or little desire to recover b) No or little social support c) Other addictions d) Comorbid disorders

5.

Substance use disorders are progressive and deadly as substances permanently alter the brain, leading to relapse and cravings. This refers to the of addiction. a) progressive concept b) progressive nature c) disease concept d) progressive disease

6.

Motivational interviewing for alcohol-related disorders involves which three components: a) collaboration, evocation, and autonomy b) consultation, empathy, and autonomy c) consultation, evocation, and ambivalence d) collaboration, empathy, and autonomy

7.

In treating alcohol-related disorders, counselors must be especially aware of a) Transference issues b) Countertransference issues c) Counselor relapse d) Relationship dynamics

8.

One current method used to treat alcohol-related disorders is a) Interpersonal psychotherapy b) Twelve-step facilitation c) Dialectical behavior therapy d) Medication assisted treatment

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9.

A counselor using motivational interviewing for a client with an alcohol-related disorder might have as his/her main treatment goal. a) Correcting client ambivalence to change b) Challenging the client’s irrational thoughts c) Teaching the client behavioral self-control training d) Teaching the client effective coping skills

10. Which of the following best describes the social skills training approach to treating alcohol-related disorders? a) An approach used to teach client lacking social skills that may be triggering alcohol use b) An approach used to help clients repair relationships that may have been damaged because of alcohol abuse c) An approach used to teach clients skills to resist the pressures of alcohol in social situations d) An approach to help clients create a schedule of social activities to distract from alcohol temptations 11. Which of the following is considered an appropriate limit on client alcohol use post-treatment? a) The client should drink no more than once or twice per week b) The client should drink no more than once or twice per month c) The client may drink only occasionally (i.e., a few times per year) d) The client should commit to complete abstinence 12. The prognosis for alcohol-related disorders is best a) Two weeks post-treatment b) Three months post-treatment c) One year post-treatment d) Three years post-treatment 13. Which of the following drugs is most likely to be fatal at first use? a) Cannabis-related disorders b) Hallucinogen-related disorders c) Sedative/hypnotic-related disorders d) Inhalant-related disorders 14. Which of the following factors is characteristic of individuals with gambling disorder? a) Poor social skills and considerable unstructured time b) Generalized anxiety disorder and low self-esteem c) Poor social skills and low self-esteem d) Low self-esteem and considerable unstructured time 15. Which of the following best describes an approach for alcohol-related disorders that teaches controlled, moderate drinking strategies a) Twelve-step facilitation b) Behavioral self-control training c) Social skills training d) Cognitive-behavioral therapy 16. One of the most significant problems associated with gambling disorders is a) Financial troubles b) Relationship problems c) Unemployment d) Drug use 17. In treating clients with gambling disorder, one prominent counselor consideration is a) Gambling disorder is grossly untreated due to its secretive nature b) Gambling disorder is often treated, but with an unfavorable prognosis c) Gambling disorder is often treated with a favorable prognosis d) Gambling disorder is often treated with an unknown prognosis

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18. One prominent counselor consideration for clients with drug-related disorders is a) Counselors must be especially aware of countertransference issues in the relationship b) Counselors must be especially mindful of cultural and gender issues among drug-abusing clients c) Posttraumatic stress disorder is often comorbid with drug-related disorders but not assessed d) Drug-related disorders often cause relationship difficulties due to their secretive nature 19. Substance abuse is often associated with a) Divorce b) Criminal activity c) Obesity d) Poor self-esteem 20. Which gambling disorder treatment involves exposing clients to trigger situations and teaching coping skills? a) cognitive-behavioral therapy b) twelve-step approaches c) in vivo exposure with response-prevention d) behavioral interventions

Essay Question 1.

Discuss the benefits and limitations associated with twelve-step facilitation for addiction treatment.

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Chapter 9: Personality Disorders Multiple Choice Questions 1.

In treating clients with borderline personality disorder (BPD), it is essential that counselors a) Do not set rigid boundaries so that clients feel safe b) Set moderate boundaries similar to any therapeutic relationship c) Set firm boundaries so that clients feel safe d) Set firm boundaries only after clients act inappropriately

2.

Which of the following is a common treatment approach for BPD: a) Dialectical behavior therapy b) Cognitive-behavioral therapy c) Interpersonal psychotherapy d) Behavioral self-control training

3.

Clients with BPD usually require a) Long-term, intensive psychosocial therapy b) Short-term, intensive psychosocial therapy c) Long-term, non-intensive psychosocial therapy d) Short-term, non-intensive psychosocial therapy

4.

Which of the following is a prominent counselor consideration in treating clients with BPD: a) Unlike many disorders, clients with BPD are unlikely to have comorbid diagnoses b) Counselors should take a rigid approach to treatment planning so the treatment is predictable c) Clients with BPD have extremely high rates of suicide attempt d) Counselors must be especially mindful of cultural and gender issues among clients with BPD

5.

In order to be diagnosed with antisocial personality disorder, a client must display a blatant disregard for others and a) Have committed a minimum of one misdemeanor or one felony b) Have been diagnosed with conduct disorder with onset before the age of 15 c) Have been diagnosed with conduct disorder with onset at any age d) Have been diagnosed with antisocial personality disorder before the age of 21

6.

Individuals with antisocial personality disorder generally a) Do not value the opinion of others b) Try to impress others c) Display low self-esteem d) Are disinterested in success

7.

Clients with antisocial personality disorder are often court-mandated and a) Aware of their anti-social tendencies b) Internally unmotivated to change c) Internally motivated to change d) Have an unfavorable prognosis

8.

A counselor using mentalization-based therapy for a client with antisocial personality disorder might have as his/her mail treatment goal: a) Reconstructing client’s maladaptive relationship patterns and teaching coping skills b) Reducing impulsive thinking through coping skills and constructive decision-making c) Altering client ambivalence to change through motivation-based approaches d) Increasing the client’s ability to control emotions and reactions to emotions

9.

Which of the following is the most evidence-based approach for antisocial personality disorder? a) Schema-based therapy b) Mentalization-based therapy c) Cognitive-behavioral therapy d) Pharmacotherapy 72 © 2019 by Pearson Education, Inc. All rights reserved.

10. In treating clients with antisocial personality disorder, one prominent counselor consideration is: a) Clients with this disorder are more likely to abuse substances b) Clients may have great difficulty interpreting others’ motives c) Counselors should approach treatment with a problem-based focus d) Clients may be manipulative and experts at deceiving themselves 11. A counselor using schema-based therapy for a client with antisocial personality disorder might have as his/her mail treatment goal: a) Reconstructing client’s maladaptive relationship patterns and teaching coping skills b) Reducing impulsive thinking through coping skills and constructive decision-making c) Altering client ambivalence to change through motivation-based approaches d) Increasing the client’s ability to control emotions and reactions to emotions 12. In treating clients with narcissistic personality disorder, one prominent counselor consideration is: a) Clients with this disorder are more likely to abuse substances b) Clients may have great difficulty interpreting others’ motives c) Counselors should approach treatment with a problem-based focus d) Clients may be manipulative and experts at deceiving themselves 13. Which of the following is considered fundamental to counseling outcomes in clients with obsessive compulsive personality disorder? a) Early establishment of the therapeutic alliance b) Setting goals that continuously challenge the client c) Limiting feedback as it may be perceived as domineering d) Increasing clients’ internal motivation to change 14. Treating clients with narcissistic personality disorder from a cognitive-behavioral perspective is focused on a) Challenging self-important thoughts and exaggerated self-esteem b) Reconstructing client’s maladaptive relationship patterns and teaching coping skills c) Reconstructing thoughts of inferiority at the root of narcissistic behavior d) Reducing impulsive thinking through coping skills and constructive decision-making 15. In treating clients with obsessive compulsive personality disorder, counselors must be especially mindful of client tendency to a) Have obsessions and even perform certain compulsions in session b) Avoid discussing emotional information and dispute the counselor c) Be overanxious to complete treatment in a timely manner d) Have suicide ideation and commit suicide shortly after 16. In treating clients with schizoid personality disorder, it is especially important that counselors due to clients’ social detachment. a) Speak calmly b) Engage in consultation c) Speak non-directively d) Establish trust 17. Which of the following is a commonly used treatment for clients with avoidant personality disorder? a) Dialectical behavior therapy b) Psychodynamic psychotherapy c) Interpersonal psychotherapy d) Systematic desensitization 18.

is an effective treatment approach for clients with obsessive-compulsive personality disorder due to its concrete and problem-focused, rather than intuitive, nature. a) Cognitive-behavioral therapy b) Dialectical behavior therapy c) Social skills training d) Systematic desensitization

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19. Individuals with paranoid personality disorder a) Are aware of reality and their irrational thoughts b) Are unaware of reality and the fact that their thoughts are irrational c) Tend to have many comorbid diagnoses, such as paranoid schizophrenia d) Tend to be diagnosed more often as adults than children 20. A client who has a need to be the center of attention and is excessively emotional may meet the diagnostic criteria for a) Paranoid personality disorder b) Schizoid personality disorder c) Borderline personality disorder d) Histrionic personality disorder 21. In treating clients with schizotypal personality disorder, one prominent counselor consideration is that a) Counselors should avoid too much self-exploration in the early stages of treatment b) Counselors must be especially aware of transference and countertransference issues c) Clients may not trust others and be suspicious of their intentions d) Clients may be manipulative and experts at deceiving themselves 22.

therapy for histrionic personality disorder involves bringing awareness to and correcting clients’ problematic behaviors in session. a) Cognitive-behavioral therapy b) Dialectical behavior therapy c) Functional analytic psychotherapy d) Cognitive analytic therapy

23. In the psychodynamic approach to treating clients with dependent personality disorder, counselors work with clients to a) Revisit and resolve past relationships through transference in treatment b) Reframe erroneous thinking, such as dichotomous views of independence c) Establish new routines of becoming more independent d) Empower clients through positive self-talk and encouragement from the counselor

Essay Question 1.

Benjamin comes to your office and tells you that, although he desires close relationships, his fears of rejection and inadequacy cause him to be timid is social situations and withdraw from others. Please discuss which diagnosis you would consider in Benjamin’s case and why. In addition, please discuss at least one treatment approach you would use in working with Benjamin.

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Chapter 10: Schizophrenia Spectrum and Other Psychotic Disorders Multiple Choice Questions 1. Rebecca becomes very angry when her counselor asks confrontational questions surrounding Rebecca’s romantic relationship with her boss. The counselor may want to consider further investigation of which psychotic-related disorder? a) Brief psychotic disorder b) Delusional disorder c) Borderline personality disorder d) Schizoaffective disorder 2. Which of the following best represents an example of a negative symptom in psychosis? a) Auditory hallucinations b) Non-bizarre delusions c) Disorganized thought d) Poverty of speech 3. Which of the following does not best represent a key symptom of psychosis? a) Mood b) Hallucinations c) Delusions d) Disorganized behavior 4. A counselor recommends social skills training for a client diagnosed with schizophrenia. Which best describes the focus of a social skills training intervention? a) Prescribing antipsychotics b) Learning appropriate behavior and communication c) Residential support d) Inpatient hospitalization 5. Which of the following best represents an example of a positive symptom in psychosis? a) Poverty of speech b) Alogia c) Disorganized behavior d) Disturbance of affect 6. Roberto is diagnosed with delusional disorder. He reports multiple incidents at work in which his coworkers have tried to steal his clients. Which subtype of delusional disorder best represents Roberto’s presenting symptoms? a) Persecutory b) Jealous c) Grandiose d) Erotomanic 7. Which of the following medications would not likely be prescribed to alleviate psychotic symptoms? a) Risperidone b) Buspar c) Olanzapine d) Haloperidol 8. Treatment for schizoaffective disorder may include: a) Antipsychotics, mood stabilizers, and hospitalization b) Stimulants c) Schema Therapy d) Antipsychotics and Acceptance and Commitment Therapy

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9. For the past month, Tim has been experiencing delusions, hallucinations, and disorganized speech. Based on these symptoms, which diagnosis would you give to Tim? a) Schizophrenia b) Schizoaffective disorder c) Schizophreniform disorder d) Delusional disorder 10. After a series of distressful events, Maria requires inpatient hospitalization to stabilize the sudden onset of hallucinations and delusions. After two weeks Maria no longer experiences psychosis and she begins outpatient counseling to improve coping skills. Which of the following best represents the potential diagnosis for Maria? a) Schizophreniform b) Schizophrenia c) Delusional disorder d) Brief psychotic disorder 11. Caroline presents to counseling with minimal impact to her social or occupational functioning. Her continued presenting problem is that her partner is having an affair. The counselor is unable to ascertain the evidence to support the accusations. Which of the following disorders best represents Caroline’s presentation? a) Borderline personality disorder b) Bipolar I disorder c) Delusional disorder d) Schizoaffective disorder 12. Taylor reports her stomach is porous therefore she will not drink any liquids and only eat bread products.

Which of the following best categorizes her presenting symptom? a) Delusion b) Hallucination c) Avolition d) Echopraxia 13. Gus presents with delusions and hallucinations. The counselor may consider the following disorder(s) during assessment: a) Psychotic disorders, factitious disorder, and bipolar II disorder b) Psychotic disorders, factious disorder, and substance induced disorders c) Bipolar II disorder, substance induced disorders, and anxiety disorders d) Factitious disorder, bipolar II, and substance-induced disorders 14. Marta consistently references monkelos during her counseling session. The counselor has come to learn that monkelos are evil creatures hiding in walls. Marta is presenting with which of the following positive symptoms: a) Speech derailment b) Neologism c) Echolalia d) Tactile hallucination 15. Juan is diagnosed with schizophrenia. He has difficulty maintaining personal hygiene and completing household tasks. Which of the following best categorizes his symptoms? a) Avolition b) Alogia c) Auditory hallucination d) Delusion 16. Theo received inpatient hospitalization three times for symptoms of psychosis. After four months, he stabilizes and no longer presents with a constellation of symptoms. Which of the following best represents a potential diagnosis for Theo? a) Schizoaffective disorder, bipolar type b) Schizophrenia c) Schizoaffective disorder, depressive type d) Schizophreniform disorder 76 © 2019 by Pearson Education, Inc. All rights reserved.

17. Which of the following indicate a potential for poorer prognosis with psychotic disorders? a) Negative symptoms b) Positive symptoms c) Limited mobility d) Extreme negativism 18. Which of the following is not a pillar of treatment for schizophrenia? a) Medication b) Psychosocial approaches c) Insight-oriented counseling d) Rehabilitation services 19. Attention to immediate safety and environmental structuring is most important during which phase of the treatment process for psychotic disorders? a) Acute b) Stabilization c) Stable d) Maintenance

Essay Questions 1.

Andre presents to counseling with symptoms of psychosis including delusional thoughts, auditory hallucinations, and disorganized speech. Please describe your assessment process of Andre.

2.

Maggie is diagnosed with schizoaffective disorder, bipolar type. Please describe your treatment approach for Maggie.

3.

You are working with a client whom you suspect is experiencing a delusional disorder. Describe the challenges of working with this client and how you would overcome them.

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Chapter 11: Feeding and Eating Disorders Multiple-Choice Questions 1.

Medications used to treat bulimia nervosa include a) SSRI’s, antidepressants, and topiramate b) SSRI’s, antidepressants, and zonisamide c) SSRI’s and topiramate d) Medication has not been proven effective

2.

Restricting type anorexia can be described as a) Losing weight through dieting and sometimes exercise b) Losing weight through dieting and exercise c) Losing weight through dieting and sometimes purging, excessive exercise, and/or laxative use d) Losing weight through purging, excessive exercise, and/or laxative use

3.

Family treatment is especially important in which of the following disorders: a) Bulimia b) Pica c) Binge eating disorder d) Anorexia

4.

The following are components of cognitive behavioral therapy in treating anorexia a) Weight restoration, transitioning control back to the adolescent, and termination b) Psychoeducation, modifying treatment plan, and relapse prevention c) Documenting food intake, finding alternatives to ED behaviors, and correcting faulty cognitions d) Weight restoration, psychoeducation, and correcting faulty cognitions

5.

The first step in dialectical behavior therapy for bulimia is a) Improving interpersonal effectiveness b) Addressing mood regulation issues c) Targeting life-threatening behaviors d) Increasing mindfulness

6.

Binge eating disorder differs from regular over-eating in that a) It is often done in the presence of others b) It is associated with more weight gain c) Individuals feel a loss of control over their behavior d) Binge eating episodes generally last longer

7.

Pica involves a) Refusing certain foods based on sensory characteristics b) The consumption of non-food substances c) Repeated regurgitation of swallowed or partially digested food d) Weight loss primarily through dieting

8.

Pica is most common among a) Children under age 2 b) Women c) Men d) Individuals with a developmental or intellectual disability

9.

Rumination disorder involves a) Obsessive regretful thoughts regarding past mistakes b) Refusing certain foods based on sensory characteristics c) The consumption of non-food substances d) Repeated regurgitation of swallowed or partially digested food

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10. Contingency management in avoidant/restrictive food intake disorder involves a) Evaluating antecedents and consequences to target problem behavior b) Reinforcing desired behaviors and gradually introducing child to new eating habits c) Modeling of healthy eating by parents d) Forcing child to eat restricted foods 11. In rumination disorder, aversive techniques and positive reinforcement involves a) Pairing unpleasant stimuli with regurgitation and positive stimuli with reduction in regurgitation b) Teaching relaxation methods and distracting the child from the urge to regurgitate c) Eating slower and more often, and oral stimulation d) Parental modeling, teaching, and endorsement of healthy eating habits (i.e., not regurgitating) 12. One potential cause of rumination disorder in children includes: a) Being over or under fed b) Having a comorbid medical condition c) Poor parent-child relations d) Bullying 13. Environmental restructuring in pica treatment involves a) Replacing the urge to eat non-food substances with other behaviors b) Positively reinforcing improvement behaviors c) Closely monitoring the environment and removing non-food items d) Pairing aversive stimuli with the eating of non-food substances 14. Avoidant/restrictive food intake disorder involves a) Refusing to eat certain foods based on sensory characteristics b) Weight loss through restrictive dieting c) The consumption of non-food substances d) Repeated regurgitation of swallowed or partially digested food 15. Which treatment for avoidant/restrictive food intake disorder involves reinforcing desired behaviors and gradually introducing the child to new eating habits? a) Shaping b) Contingency management c) Parent training and family counseling d) Positive Reinforcement 16. Satiation in rumination disorder involves a) Oral stimulation b) Eating less often c) Eating faster d) Eating from all food groups 17. Which of the following is involved in behavioral management in treating pica disorder? a) Classical conditioning b) Controlling the environment c) Visual screening/blocking d) Positive reinforcement 18. Binge eating disorder is most common among which group: a) Men b) Women c) Children d) It is equally common among each of these groups

Essay Questions 1.

Discuss the use of dialectical behavior therapy in binge eating disorder and bulimia.

2.

Discuss the steps of enhanced cognitive-behavior therapy for eating disorders in anorexia and how it differs from cognitive-behavioral therapy.

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Chapter 12: Disruptive, Impulse-Control, Conduct, and Elimination Disorders

Multiple Choice Questions 1.

How old must a client be to have a diagnosis of enuresis? a) 2 years old b) 3 years old c) 4 years old d) 5 years old

2.

How old must a client be to have a diagnosis of encopresis? a) 2 years old b) 3 years old c) 4 years old d) 5 years old

3.

The most effective way to treat nocturnal enuresis is: a) punishment b) enuresis alarm c) toilet training d) applied behavioral analysis

4.

A nutritional change that might help treat encopresis is: a) addition of fiber b) addition of sugar c) addition of fats d) reduction of fiber

5.

The most effective and accessible behavioral reinforcer is: a) verbal praise b) food c) candy d) punishment

6.

Counselors working with encopresis without constipation and overflow incontinence should: a) suggest an enuresis alarm b) assess for conduct disorder c) suggest dietary changes d) employ CBT

7.

Children with oppositional defiant disorder (ODD) a) are typically female b) have limited emotional reactivity c) have low frustration tolerance d) typically comply with authority figures

8.

Counselor working with ODD should a) avoid individual interventions b) insist that families participate in treatment c) always use play therapy d) identify client strengths

9.

School interventions for clients with ODD a) should involve clients’ teachers and peers b) are not recommended c) are too complex for most counselors to implement d) harmful for clients

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10. Clients with conduct disorder (CD) a) have high empathy for others b) only exhibit destructive behaviors periodically c) often harm themselves or others d) are generally well-adjusted, happy people 11. Childhood onset of CD is characterized by onset of symptoms before the age of a) 7 b) 10 c) 12 d) 13 12. For clients with CD, structure within the home environment a) is typically very high b) causes the client to feel over-regulated c) should be emphasized by the counselor d) is very easy for parents to implement 13. Clients with intermittent explosive disorder a) are typically provoked to act violently b) feel no remorse for their actions c) are otherwise well-adjusted people d) always remember their violent behaviors 14. Individuals with pyromania a) set fires to impress others b) set fires to relieve their own unwanted feelings c) are motivated by financial gain d) are just curious about fire 15. Individuals with kleptomania are motivated to steal a) for potential financial gain b) for personal satisfaction c) because they need the specific item d) because they are dared to do it 16. Individuals with kleptomania are typically a) male b) in need of the items they steal c) easily treated by counselors d) relieved after committing an act of stealing 17. Treatment for kleptomania a) well-understood at this time b) includes cognitive behavioral interventions c) should include a psychopharmaceutical component d) is relatively effective 18. The prognosis on encopresis a) is very good b) is challenging c) is well-understood d) affected by the weather 19. When working with enuresis and encopresis, counselors should always a) rule out general medical conditions b) scold the child c) read stories to the client d) utilize psychoanalytic interventions

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20. Parents of children with ODD a) typically have low levels of stress b) implement very regular parenting interventions c) respond to their children gently d) can unknowingly reinforce their child’s behavior

Essay Questions 1.

Briefly describe two skills that can be used by a counselor utilizing behavioral therapy to work with clients who have oppositional defiant disorder or conduct disorder.

2.

Operant behavioral interventions are used to treat enuresis. Briefly describe the two forms of operant behavioral interventions (i.e., reinforcement and punished) and how they can be used in counseling children with enuresis.

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Chapter 13: Neurodevelopmental and Neurocognitive Disorders Multiple Choice Questions 1.

Two key diagnostic features of attention-deficit/hyperactivity disorder include: a) hyperactive symptoms and an ability to hyperfocus on interesting tasks b) hyperactive symptoms and below average grades c) difficulty focusing on tasks and hyperactive symptoms d) difficulty focusing on tasks and an ability to hyperfocus on interesting tasks

2.

Applied behavior analysis a) uses operant conditioning to teach age appropriate skills b) focuses on reducing stimming c) emphasizes natural reinforcement in the environment d) uses visual tools to promote learning and comprehension

3.

Hypoactive delirium involves a) agitation, restlessness, delusions, and hallucinations b) fatigue and changes in appetite or social functioning c) both fatigue and restlessness/agitation d) agitation and restlessness

4.

The most critical aspect of treating delirium is a) Psychoeducation b) Calm disposition of the counselor c) Early detection d) Relaxation exercises

5.

Stimming refers to a) Repeating what is heard b) Flapping the hands or rocking c) Repeating quotes from books or movies d) Obsessive ritualized behavior

6.

Narrative therapy for communication disorders a) Involves sharing experiences and creating a new identity b) Involves creating behavioral experiments c) Involves increasing self-awareness and mindfulness d) Involves speaking in anxiety-provoking situations

7.

An individual with intellectual disability usually presents with an IQ at or below no longer required for diagnosis in the DSM-5. a) 60 b) 70 c) 80 d) 90

8.

The difference between neurocognitive major and minor disorders refers to the a) Progression of the disorder b) Number of symptoms c) Amount of memory loss d) Age of the client with the disorder

9.

Reminiscence therapy for neurocognitive disorders involves a) Reliving memories by talking with a counselor b) Identifying behavior patterns, relaxation, and pleasant event situations c) Relaxation techniques, recording daily thoughts, and increasing socialization d) Educating caregiver(s) on the disorder, treatment goals, and caregiver issues

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, although it is

10. In treating neurocognitive disorders, pleasant event situations refer to a) Reminiscing about past happy memories b) Identifying an enjoyable activity and increasing its frequency c) Identifying an enjoyable activity and thinking about it at least twice per week d) Increasing one’s visitation in a nursing home 11. Developmental coordination disorder refers to a) Disturbance in attention, consciousness, language, thought processes, visuospatial abilities, orientation, and memory b) Significant social communication impairments and restrictive and repetitive behavior, interests, or activities c) Stuttering, pronunciation difficulties, omitting or distorting sounds d) Difficulties in balance, manual dexterity, agility, and locomotion 12. The Specific Skills Approach in developmental coordination disorders focuses on a) improving motor skills b) sensory integration techniques c) muscle-strengthening techniques d) improving self esteem 13. Tourette’s disorder involves a) either motor or visual tics lasting for at least a year. b) both motor and visual tics lasting for at least a year c) either motor or visual tics that can be present for under one year. d) tic symptoms that do not meet criteria for any of the above disorders 14. Stereotypic movements a) cannot be suppressed b) can be suppressed by distraction c) can be suppressed by rehearsal therapy d) can be suppressed by willpower 15. Which of the following therapies is based on the premise that tics are reinforced by positive or negative rewards for tick behavior: a) Group therapy b) Behavior therapy c) Cognitive behavioral therapy d) Behavioral activation therapy 16. Communication disorders refer to a) Disturbance in attention, consciousness, language, thought processes, visuospatial abilities, orientation, and memory b) Significant social communication impairments and restrictive and repetitive behavior, interests, or activities c) Stuttering, pronunciation difficulties, and omitting or distorting sounds d) Difficulties in balance, manual dexterity, agility, and locomotion 17. Early intensive behavioral intervention a) uses operant conditioning to teach age appropriate skills b) focuses on reducing stimming behaviors c) emphasizes natural reinforcement in the environment d) uses visual tools to promote learning and comprehension 18. The TEACCH Method a) uses operant conditioning to teach age appropriate skills b) focuses on reducing stimming behaviors c) emphasizes natural reinforcement in the environment d) uses visual tools to promote learning and comprehension

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19. In treating specific learning disorder, one prominent counselor consideration is: a) Assessing for comorbid disorders b) Reducing environmental distractions c) Client’s age and grade in school d) Assessing for cultural factors 20. One counselor consideration in treating neurocognitive major and minor disorders includes: a) Assessing for cultural factors b) Examining a client’s past development c) Assessing for escalation of symptoms d) Providing praise and encouragement

Essay Questions 1.

Describe at least two treatment options for attention-deficit/ hyperactivity disorder.

2.

What are some important counselor considerations in treating clients with intellectual disability?

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Chapter 14: Dissociative Disorders and Somatic Symptom and Related Disorders Multiple Choice Questions 1.

The creation of different personalities to protect from traumatic experiences might be diagnosed as: a) Somatic symptom disorder b) Dissociative amnesia c) Dissociative identity disorder d) Depersonalization/derealization disorder

2.

The cornerstone of any therapeutic intervention used in the treatment of somatic symptom and related disorders or dissociative disorders is: a) Building a strong therapeutic relationship and rapport with the client b) Administering the Beck Depression Inventory c) Prescribing medication to treat the client’s symptoms d) Determining the source of the client’s symptomology

3.

A female client who is diagnosed with a mild form of arthritis and reports inability to get out of bed and perform activities of daily living might meet the diagnostic criteria for: a) Illness anxiety disorder b) Somatic symptom disorder c) Factitious disorder d) Depersonalization/derealization disorder

4.

Doctor shopping is common among clients diagnosed with somatic symptom and related disorders and is defined as: a) Asking family members and friends for referrals to qualified medical professionals b) Going to another physician to get a second opinion on a diagnosis and treatment c) Seeking medical treatment from many medical professionals with the goal of obtaining a medical diagnosis d) Finding a primary care physician to diagnosis and treat general medical concerns

5.

Which of the following is used to aid in the assessment of dissociative disorders: a) Dissociative Experiences Scale b) Retroactive Amnesia Subscale c) Dissociative Identity Inventory d) Depersonalization Inventory

6.

The presence of neurological symptomology for which there is no organic cause or medical explanation might lead to a diagnosis of: a) Conversion disorder b) Dissociative amnesia c) Factitious disorder d) Somatic symptom disorder

7.

A holistic treatment team approach is recommended when providing mental health services to individuals diagnosed with somatic symptom and related disorders and would include: a) Only the counselor b) Everyone involved in the client’s care including but not limited to medical care professionals, case managers, family members, and friends c) Only mental health professionals including but not limited to the psychiatrist, case manager, and social worker d) Only medical professionals

8.

A female client who is falsifying her daughter’s symptoms of asthma without any apparent personal gain might meet the diagnostic criteria for: a) Psychological factors affecting other medical conditions b) Dissociative amnesia c) Factitious disorder imposed on another d) Factitious disorder imposed on self 86 © 2019 by Pearson Education, Inc. All rights reserved.

9.

Inability to remember pieces or the whole of one’s past for which there is no organic cause or medical explanation might lead to a diagnosis of: a) Dissociative identity disorder b) Depersonalization/derealization disorder c) Psychological factors affecting other medical conditions d) Dissociative amnesia

10. Research shows that sequential treatment focused on symptom regulation and narrative storytelling is an effective approach when providing services to clients with symptoms of: a) Dissociative amnesia and dissociative identity disorder b) Dissociative identity disorder and depersonalization/derealization disorder c) Dissociative amnesia and depersonalization/derealization disorder d) Dissociative identity disorder and retroactive amnesia 11.

is/are a consideration for counselors providing services to clients diagnosed with somatic symptom and related disorders and dissociative disorders given the shared symptomology with other psychological disorders. a) Suicide b) Differential diagnoses c) Comorbidity d) Substance abuse

12. A male client who reports being concerned about his job security and financial situation while also reporting an increase in asthma attacks might be diagnosed with: a) Somatic symptom disorder b) Illness anxiety disorder c) Depersonalization/derealization disorder d) Psychological factors affecting other medical conditions 13. Integration is oftentimes the therapeutic goal for clients diagnosed with: a) Psychological factors affecting other medical conditions b) Dissociative amnesia c) Dissociative identity disorder d) Depersonalization/derealization disorder 14. Excessive concern about the acquisition of a serious illness might meet the diagnostic criteria for: a) Factitious disorder b) Illness anxiety disorder c) Depersonalization/derealization disorder d) Somatic symptom disorder 15. A female client who reports an experience where the world around her appeared distorted as though she was looking at everything from inside a bubble might be describing: a) Derealization b) Factitious disorder c) Depersonalization d) Dissociative amnesia 16. Assessment for somatic symptom and related disorders should include the following domains: a) Biological, key areas of functioning, and suicide risks b) Biological, key areas of functioning, and cognitive c) Biological, personality, and cognitive d) Biological, self-awareness, and suicide risks 17. A male client who recounts an experience where he was hovering over his body observing himself cook a meal might be describing: a) Depersonalization b) Conversion disorder c) Derealization d) Psychological factors affecting other medical conditions

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18. The prognosis of individuals with dissociative amnesia is a) Favorable b) Unfavorable c) Specific to symptom severity d) Difficult to predict

Essay Questions Jacob is a 20-year-old Italian American male who presents to counseling after being arrested for assault. During the intake interview, Jacob tells you that he was arrested six months earlier for physically assaulting his 25-yearold sister. However, Jacob remembers nothing about the event. As Jacob recalls, on the day of the assault, he left work around 10:00 p.m. and started walking home. He was confronted by three men who held a gun to his head while demanding Jacob give them his wallet. Giving the men his wallet is the last thing Jacob remembers.

The next memory Jacob has is being read his rights and handcuffed by the police. Jacob has pieced together the events that took place based on what others have told him. Accordingly, Jacob continued walking home, and, when he arrived home, physically assaulted his sister when she asked how his day was and then damaged some of her personal property (i.e., threw a chair through a window). Jacob discloses feeling guilt and embarrassment over the event stating, “that’s not normal.” Jacob has been referred to counseling for anger management.

Essay Question 1: What diagnosis would you give Jacob and why? Please provide a one to two paragraph explanation for the diagnostic criteria you believe is being met in the case study. Please be specific and clear when describing the diagnosis and any supporting evidence.

Essay Question 2: Create a treatment plan for Jacob. Please ensure you include the following components: (1) Two to three goals for the therapeutic process (2) One to two measurable objectives for each goal (3) One to two interventions to be used by the counselor to assist with the achievement of the measurable objectives and ultimately the goals Helen is a 47-year-old Alaskan Native female who was referred to counseling due to elevated blood pressure despite compliance with a medication regimen, diet, and exercise program. Helen’s primary care provider referred Helen believing that psychological issues undergird her physiological symptoms. During the intake interview, Helen tells you that she was diagnosed with hypertension approximately one year ago and has since been eating well, exercising daily, and taking her medication as prescribed. However, during last month’s check-up, her blood pressure was very high. Further investigation of life stressors revealed that Helen’s daughter was raped one month prior – something Helen did not reveal to her physician. Helen is clearly distressed while speaking about the event. Additionally, Helen reports that she and her partner have been arguing more frequently since her daughter’s rape. Helen states, “I don’t know if my marriage will last much longer.” Helen is not sure counseling can help her but is willing to try considering the recommendation of the referring physician.

Essay Question 3: What diagnosis would you give Helen and why? Please provide a one to two paragraph explanation for the diagnostic criteria you believe is being met in the case study. Please be specific and clear when describing the diagnosis and any supporting evidence.

Essay Question 4: Create a treatment plan for Helen. Please ensure you include the following components: (1) Two to three goals for the therapeutic process (2) One to two measurable objectives for each goal (3) One to two interventions to be used by the counselor to assist with the achievement of the measurable objectives and ultimately the goals

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Chapter 15: Sleep-Wake Disorders, Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria Multiple Choice Questions 1.

Which of the following can exacerbate sexual dysfunction: a) Diet b) Medication c) Performance anxiety d) Alcohol

2.

Of which of the following issues should counselors be especially aware when treating individuals with sexual dysfunction? a) Transference b) Countertransference c) Therapeutic alliance d) Intimacy

3.

Children may sleep-walk due to a) Anxieties related to changes in family structure, etc. b) Depression c) Changes in sleep schedule d) Imbalances in brain chemicals

4. a) b) c) d)

is the most evidence-based approach for erectile dysfunction.

Medication and group therapy Medication and cognitive behavioral therapy Medication and behavioral therapy Medication and rational emotive therapy

5.

The most evidence-based treatment for obstructive sleep apnea is a) Maxillomandibular advancement b) Medication c) Cognitive-behavioral therapy d) Behavior therapy

6.

Which of the following is/are used as treatment(s) for sexual desire disorders: a) Behavior therapy b) Interpersonal psychotherapy c) Dialectical behavioral therapy d) Family therapy

7.

Sexual masochism disorder a) Involves an individual being arousal by observing another being physically or psychologically made to suffer; the person may or may not have acted on these urges with a nonconsenting person b) Involves an individual being sexually aroused by being sexually humiliated, beaten, bound, and made to suffer during sexual activity c) Involves an individual acting on the urge to rub against or touch an individual without his or her consent d) Involves an individual acting on the urge to observe an unsuspecting person either nude or disrobing, or an unsuspecting person engaged in sexual behavior.

8.

Gender dysphoria is most common among which group: a) Women b) Men c) Children d) It is equally common among each group 89 © 2019 by Pearson Education, Inc. All rights reserved.

9.

Which of the following disorders is generally resistant to treatment: a) Sleep disorders b) Sexual dysfunction disorders c) Paraphilia d) Insomnia

10. Parasomnia refers to a) Abnormal behaviors or events happening between the threshold of wake and sleep b) Difficulty in initiating, maintaining, or returning to sleep c) Breathing-related sleep disturbance d) Excessive sleepiness 11. The primary treatment for hypersomnia is: a) Cognitive-behavioral therapy b) Medication c) Behavior therapy d) Rational-emotive therapy 12. Which of the following are behavioral interventions for sleep apnea: a) Weight loss and dieting b) Using oral applications c) Sleep hygiene and controlling one’s sleep environment d) Decreasing smoking and alcohol consumption 13. Which of the following disorders involves increasing tension that is released only when one acts on a desired impulse: a) Sexual dysfunction disorders b) Sexual desire disorders c) Paraphilic disorders d) Gender dysmorphic disorder 14. Medications are a first resort, but often a temporary solution in treating which of the following disorders: a) Insomnia b) Hypersomnia c) Sleep apnea d) Circadian rhythm sleep-wake disorder 15. Acceptance on the part of the counselor is especially important in treating which of the following disorders: a) Sexual dysfunction disorders b) Sexual desire disorders c) Paraphilia d) Gender dysphoria 16. Circadian rhythm sleep-wake disorder refers to a) The mismatch between external and internal sleep-wake systems b) Abnormal behaviors or events that happen to individuals between the thresholds of wake and sleep c) The vocalization or complex behaviors during rapid eye movement [REM] stages of sleep d) Disruption in sleep which leads to sleep avoidance and sleep deprivation 17. Which of the following issues confound assessment and treatment of sexual dysfunction: a) Boredom in sexual routine b) Quality of couple’s relationship c) Interference of medication d) Current life stressors

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18. In treating clients with paraphilia, cognitive-behavioral therapy may involve: a) Recognizing deviant cognitions and orgasmic reconditioning b) Aversion therapy and orgasmic reconditioning c) Aversion therapy and extinction d) Recognizing deviant cognitions and self-policing strategies

Essay Questions 1.

Please describe the treatment options for the following sexual dysfunction disorders: female orgasmic disorder and premature ejaculation.

2.

What are some important counselor considerations in treating clients with gender dysphoria?

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Test Bank Answer Key

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