PSYCHOTHERAPY FOR THE ADVANCED
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
1 — Stem: A newly graduated PMHNP begins her first
outpatient psychotherapy clinic. In the first session a middle-
aged patient with chronic depression asks for “quick fixes” and
expects the clinician to give immediate solutions. The PMHNP
wonders whether to prioritize symptom reduction or explore
underlying relational patterns. Which approach best reflects
Wheeler’s hierarchical, stage-based framework when alliance is
fragile but functioning is impaired?
,A. Prioritize symptom relief with brief behavioral strategies and
safety planning, deferring deeper relational work.
B. Immediately begin psychodynamic interpretation to uncover
early attachment conflicts driving current depression.
C. Refuse symptomatic interventions and insist on long-term
exploratory therapy to address root causes.
D. Focus only on medication management and refer
psychotherapy elsewhere.
Correct answer: A
Rationale (correct): Wheeler’s framework uses a hierarchy of
treatment aims and stage model that prioritize stabilization and
functioning early when symptoms impair life and alliance is still
forming. Brief behavioral strategies (e.g., behavioral activation,
safety planning) are evidence-based for acute symptom relief
and allow the therapeutic relationship to build before deeper
relational work.
Rationale (incorrect):
B — Premature: deep psychodynamic interpretation is
premature when the patient needs immediate symptom relief
and the alliance is fragile.
C — Ineffective/rigid: refusing symptom relief risks safety and
undermines engagement.
D — Misaligned: medication alone neglects the role of
psychotherapy in holistic, relationship-based care; unnecessary
referral fragments care.
,Teaching point: Stabilize functioning and alliance before moving
to deeper exploratory work.
Citation (Simplified APA): Wheeler, K. (2023). Psychotherapy for
the Advanced Practice Psychiatric Nurse (3rd ed.). Ch. 1.
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
2 — Stem: A PMHNP notices she feels unusually protective and
wants to “rescue” a young adult patient whose trauma history
she recently reviewed. The patient shows increased
dependency. According to Wheeler’s discussion of nurse-
therapist strengths and common countertransference, which
clinician action is most appropriate?
A. Accommodate the patient’s requests beyond session limits to
avoid abandonment.
B. Refer the patient immediately to another clinician to avoid
boundary complexities.
C. Explore the clinician’s protective feelings in supervision and
maintain consistent boundaries in session.
D. Share personal experiences to normalize dependency and
build rapport.
Correct answer: C
Rationale (correct): Wheeler emphasizes self-awareness,
supervision, and maintaining therapeutic boundaries; exploring
countertransference in supervision supports clinician reflection
, and preserves a healing, empowerment-focused stance while
maintaining consistent limits.
Rationale (incorrect):
A — Ethically inappropriate: over-accommodation fosters
dependency and undermines empowerment.
B — Premature: referral may be unnecessary if clinician
recognizes and manages countertransference via supervision.
D — Boundary risk: self-disclosure can blur boundaries and may
shift focus away from the patient’s needs.
Teaching point: Use supervision to process
countertransference; hold steady, therapeutic boundaries.
Citation (Simplified APA): Wheeler, K. (2023). Psychotherapy for
the Advanced Practice Psychiatric Nurse (3rd ed.). Ch. 1.
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
3 — Stem: A PMHNP working with an immigrant family notices
that their explanatory model of mental illness emphasizes
spiritual causes and family shame. The family resists CBT
techniques framed in Western biomedical terms. Which
clinician move best aligns with Wheeler’s culture-lens holistic
model?
A. Insist on CBT techniques because they are evidence-based
and universally applicable.
B. Adapt interventions to include culturally congruent
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
1 — Stem: A newly graduated PMHNP begins her first
outpatient psychotherapy clinic. In the first session a middle-
aged patient with chronic depression asks for “quick fixes” and
expects the clinician to give immediate solutions. The PMHNP
wonders whether to prioritize symptom reduction or explore
underlying relational patterns. Which approach best reflects
Wheeler’s hierarchical, stage-based framework when alliance is
fragile but functioning is impaired?
,A. Prioritize symptom relief with brief behavioral strategies and
safety planning, deferring deeper relational work.
B. Immediately begin psychodynamic interpretation to uncover
early attachment conflicts driving current depression.
C. Refuse symptomatic interventions and insist on long-term
exploratory therapy to address root causes.
D. Focus only on medication management and refer
psychotherapy elsewhere.
Correct answer: A
Rationale (correct): Wheeler’s framework uses a hierarchy of
treatment aims and stage model that prioritize stabilization and
functioning early when symptoms impair life and alliance is still
forming. Brief behavioral strategies (e.g., behavioral activation,
safety planning) are evidence-based for acute symptom relief
and allow the therapeutic relationship to build before deeper
relational work.
Rationale (incorrect):
B — Premature: deep psychodynamic interpretation is
premature when the patient needs immediate symptom relief
and the alliance is fragile.
C — Ineffective/rigid: refusing symptom relief risks safety and
undermines engagement.
D — Misaligned: medication alone neglects the role of
psychotherapy in holistic, relationship-based care; unnecessary
referral fragments care.
,Teaching point: Stabilize functioning and alliance before moving
to deeper exploratory work.
Citation (Simplified APA): Wheeler, K. (2023). Psychotherapy for
the Advanced Practice Psychiatric Nurse (3rd ed.). Ch. 1.
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
2 — Stem: A PMHNP notices she feels unusually protective and
wants to “rescue” a young adult patient whose trauma history
she recently reviewed. The patient shows increased
dependency. According to Wheeler’s discussion of nurse-
therapist strengths and common countertransference, which
clinician action is most appropriate?
A. Accommodate the patient’s requests beyond session limits to
avoid abandonment.
B. Refer the patient immediately to another clinician to avoid
boundary complexities.
C. Explore the clinician’s protective feelings in supervision and
maintain consistent boundaries in session.
D. Share personal experiences to normalize dependency and
build rapport.
Correct answer: C
Rationale (correct): Wheeler emphasizes self-awareness,
supervision, and maintaining therapeutic boundaries; exploring
countertransference in supervision supports clinician reflection
, and preserves a healing, empowerment-focused stance while
maintaining consistent limits.
Rationale (incorrect):
A — Ethically inappropriate: over-accommodation fosters
dependency and undermines empowerment.
B — Premature: referral may be unnecessary if clinician
recognizes and manages countertransference via supervision.
D — Boundary risk: self-disclosure can blur boundaries and may
shift focus away from the patient’s needs.
Teaching point: Use supervision to process
countertransference; hold steady, therapeutic boundaries.
Citation (Simplified APA): Wheeler, K. (2023). Psychotherapy for
the Advanced Practice Psychiatric Nurse (3rd ed.). Ch. 1.
Ch. 1 — The Nurse Psychotherapist and a Framework for
Practice
3 — Stem: A PMHNP working with an immigrant family notices
that their explanatory model of mental illness emphasizes
spiritual causes and family shame. The family resists CBT
techniques framed in Western biomedical terms. Which
clinician move best aligns with Wheeler’s culture-lens holistic
model?
A. Insist on CBT techniques because they are evidence-based
and universally applicable.
B. Adapt interventions to include culturally congruent
