PSYCHOTHERAPY FOR THE ADVANCED
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
1
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A 34-year-old client with recurrent major depressive episodes
says in session, “I feel like therapy is just another place where
people tell me what to do.” The client’s affect is flat and they
withdraw when the nurse asks about therapy goals. As a nurse
,psychotherapist who emphasizes a collaborative framework,
which immediate therapist response most aligns with Wheeler’s
model to rebuild alliance and engage the client in care
planning?
Options
A. Gently confront the client about avoidance and insist on
setting measurable goals for the next session.
B. Acknowledge the client’s experience, invite the client to
describe what ‘help’ would look like, and co-develop a small,
client-chosen objective.
C. Shift to psychoeducation about depression and the evidence
for specific behavioral interventions to convince the client
therapy helps.
D. Maintain neutrality and avoid discussing the client’s feelings
about therapy to prevent reinforcing resistance.
Correct Answer
B
Rationales
• Correct (B): Acknowledging the client’s experience and
inviting collaboration fits Wheeler’s nurse-psychotherapist
stance: prioritizing therapeutic alliance, shared decision-
making, and negotiated goals to enhance engagement.
Small client-chosen objectives respect autonomy and build
efficacy.
, • Incorrect (A): Direct confrontation and insistence on goals
is likely premature and risks rupturing the alliance; it
neglects the relational work needed first.
• Incorrect (C): Psychoeducation may be useful later, but
immediate didactic persuasion risks invalidating the client’s
experience and misses an opportunity to co-create goals.
• Incorrect (D): Avoiding the topic neglects alliance repair
and misses a therapeutic opening; neutrality here equals
missed engagement.
Teaching Point
Begin with alliance-building and collaborative goal-setting
before directive interventions.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
During supervision, a novice nurse psychotherapist describes
feeling unusually angry toward a client who frequently cancels
sessions. The supervisor asks how this feeling might affect
, treatment decisions. What supervisory focus best reflects
Wheeler’s recommended framework for managing clinician
countertransference?
Options
A. Recommend the clinician refer the client because
countertransference indicates poor clinician–client fit.
B. Coach the clinician to explore personal triggers, consider
their impact on interventions, and plan reparative, client-
centered steps.
C. Encourage the clinician to minimize expression of feelings
and maintain strict professional distance.
D. Suggest the clinician ignore the feelings to avoid
contaminating treatment choices.
Correct Answer
B
Rationales
• Correct (B): Wheeler emphasizes reflective practice and
supervision to identify countertransference, understand its
origins, and transform it into therapeutic leverage through
planned, reparative interventions.
• Incorrect (A): Immediate referral may be unnecessary; it
avoids clinician growth and overlooks opportunities to use
the therapeutic process to address ruptures.
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
1
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
A 34-year-old client with recurrent major depressive episodes
says in session, “I feel like therapy is just another place where
people tell me what to do.” The client’s affect is flat and they
withdraw when the nurse asks about therapy goals. As a nurse
,psychotherapist who emphasizes a collaborative framework,
which immediate therapist response most aligns with Wheeler’s
model to rebuild alliance and engage the client in care
planning?
Options
A. Gently confront the client about avoidance and insist on
setting measurable goals for the next session.
B. Acknowledge the client’s experience, invite the client to
describe what ‘help’ would look like, and co-develop a small,
client-chosen objective.
C. Shift to psychoeducation about depression and the evidence
for specific behavioral interventions to convince the client
therapy helps.
D. Maintain neutrality and avoid discussing the client’s feelings
about therapy to prevent reinforcing resistance.
Correct Answer
B
Rationales
• Correct (B): Acknowledging the client’s experience and
inviting collaboration fits Wheeler’s nurse-psychotherapist
stance: prioritizing therapeutic alliance, shared decision-
making, and negotiated goals to enhance engagement.
Small client-chosen objectives respect autonomy and build
efficacy.
, • Incorrect (A): Direct confrontation and insistence on goals
is likely premature and risks rupturing the alliance; it
neglects the relational work needed first.
• Incorrect (C): Psychoeducation may be useful later, but
immediate didactic persuasion risks invalidating the client’s
experience and misses an opportunity to co-create goals.
• Incorrect (D): Avoiding the topic neglects alliance repair
and misses a therapeutic opening; neutrality here equals
missed engagement.
Teaching Point
Begin with alliance-building and collaborative goal-setting
before directive interventions.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 1.
2
Reference
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
Stem
During supervision, a novice nurse psychotherapist describes
feeling unusually angry toward a client who frequently cancels
sessions. The supervisor asks how this feeling might affect
, treatment decisions. What supervisory focus best reflects
Wheeler’s recommended framework for managing clinician
countertransference?
Options
A. Recommend the clinician refer the client because
countertransference indicates poor clinician–client fit.
B. Coach the clinician to explore personal triggers, consider
their impact on interventions, and plan reparative, client-
centered steps.
C. Encourage the clinician to minimize expression of feelings
and maintain strict professional distance.
D. Suggest the clinician ignore the feelings to avoid
contaminating treatment choices.
Correct Answer
B
Rationales
• Correct (B): Wheeler emphasizes reflective practice and
supervision to identify countertransference, understand its
origins, and transform it into therapeutic leverage through
planned, reparative interventions.
• Incorrect (A): Immediate referral may be unnecessary; it
avoids clinician growth and overlooks opportunities to use
the therapeutic process to address ruptures.
