Therapeutic Relationship
A therapist and client agree that they want therapy to help the client feel more comfortable speaking up at work. Which part of the working alliance does this illustrate?
Agreement on goals.
A therapist notices that their primary motivation for becoming a therapist is the desire to relieve suffering in others. Is this an example of heightened self-focus or stable self-awareness?
Stable self-awareness
A therapist tells a client that they will explain the risks, benefits, and alternatives of treatment before beginning. What ethical concept is this related to?
Informed consent.
What are the three stages of Hill's helping skills model?
Exploration, insight, and action.
A therapist asks, “What was that experience like for you?” Is this an open or closed question?
Open question.
A therapist notices that they genuinely enjoy working with a client and are able to be warm and authentic without pretending to feel differently than they do. What aspect of the therapeutic relationship does this demonstrate?
Genuineness/congruence.
Name one social identity that can influence a person's experiences in society.
Possible answers include race/ethnicity, gender, social class, sexual orientation, religion, disability status, nationality, etc.
A therapist consistently arrives on time, follows through on promises, and does what they tell the client they will do. Which ethical principle does this demonstrate?
Fidelity.
A therapist helps a client describe exactly what happened during a recent argument and how the client experienced it. Which stage is the therapist primarily working in?
Exploration.
A client says, “I was completely floored when I got the email.” The therapist responds, “You felt overwhelmed when you read it.” What skill is the therapist using?
Reflection of feelings.
A client becomes unusually suspicious that their therapist will abandon them and reacts to the therapist as though they were a parent who previously left them. What concept may help explain the client's reaction?
Transference
During a session, a therapist realizes they are mentally rehearsing what they are going to say next instead of listening carefully to the client. What kind of self-focus is this?
Hindering self-focus
A therapist is considering accepting a client who needs specialized treatment that the therapist has never been trained to provide. What ethical principle should they consider?
Competence/practicing with expertise.
A client realizes that their fear of speaking in meetings comes from repeatedly being criticized when they expressed opinions as a child. Which stage does this illustrate?
Insight
A client spends several minutes describing everything that happened during their first day at a new job. The therapist responds, “So you were excited at first, then became anxious when you realized you didn't know anyone, and by the end of the day you were questioning whether you'd made the right decision.” What skill is this?
Summary.
A therapist and client agree that the client wants to improve their sleep. However, the therapist wants the client to keep a detailed sleep diary while the client would rather focus on reducing stress before bed. What aspect of the working alliance needs attention?
Agreement on tasks.
What do we mean by "cultural humility"?
Cultural humility is the understanding that you can never fully know everything about someone else's culture and that your own culture isn't superior.
A therapist discovers that their client is also their neighbor. The therapist is considering inviting the client to join a neighborhood social group. What ethical concern should the therapist consider
Dual relationship. The therapist should consider whether having both a therapeutic and social relationship could create conflicts of interest and risk of exploitation.
After recognizing that procrastination is connected to their fear of failure, a client and therapist develop a plan for breaking assignments into smaller steps. Which stage is this?
Action
A client says, “I keep agreeing to help everyone, and then I get annoyed that nobody helps me.” Give an example of an open question that could help the client explore this pattern.
Possible answer: “What do you notice happens when someone asks you for help?”
A therapist realizes that they feel especially protective of a client because the client reminds them of their younger sibling. Why could this become a problem if the therapist does not recognize the reaction?
The therapist's personal feelings could influence their judgment and behavior toward the client. This could lead to countertransference and interfere with maintaining an appropriate, client-centered therapeutic relationship.
Oppression operates at 4 levels. Name and describe them.
Internalized: The process where members of a marginalized group turn oppressive beliefs inward and apply them to themselves.
Interpersonal: The person-to-person interactions where individuals express bias, prejudice, or discrimination against others.
Institutional: The network of laws, policies, and practices maintained by organizations and governments that systematically disadvantage certain groups.
Structural/cultural:The foundational beliefs, values, and societal myths that justify the superiority of one group over another.
Name and describe each part of the ABCDE ethical decision making model.
A - Assessment: The therapist identifies the ethical problem, names the affected parties, identifies which ethical standards/principles apply, and reflects on personal biases.
B – Benefit: The therapist evaluates which actions they could take and how they will maximize well-being of involved parties
C – Consequences & Consultation: The therapist weighs the risks of each option for relevant parties and consults with peers, supervisors, or legal experts for objective guidance.
D – Duty and Documentation: The therapist examines their professional obligations to involved parties and decides what to document in their notes about the decision making process.
E – Education: The therapist reviews clinical research, ethical guidelines, and their own training to ensure their final choice is grounded in current professional standards.
What are the 4 goals of the exploration stage?
Listen, attend, observe, learn about client's thoughts and narratives, establish the therapeutic relationship, and encourage the expression and experience of feelings
A client says, “I was really excited about the new job, but after my first mistake I started thinking maybe I'm not cut out for this.” Make a restatement.
“That first mistake made you start doubting whether you were capable of doing the job.”