MSN 674 PMHNP Midterm — Cheat Sheet
Chapters 1–10 | Corey & Wheeler | Scan this while doing APEA practice Qs | You've got this.
How to use this: When a practice question gives you a vignette, ask yourself three things: (1) Is the therapist being directive or following the client? (2) Is the focus on
thoughts, feelings, behavior, or the relationship? (3) Is it past-focused (psychoanalytic) or present-focused (CBT/behavior/gestalt)? That narrows it to 2 options fast.
PSYCHODYNAMIC, HUMANISTIC & EXISTENTIAL APPROACHES
THEORY + FOUNDER THE ONE THING THAT MAKES IT KEY TECHNIQUE HOW YOU USE IT AS A PMHNP
DIFFERENT
Psychoanalytic / Unconscious drives run the show. Free association + Patient fixates on you or idealizes you? That's transference —
Psychodynamic Behavior is determined by stuff the Transference analysis — let the use it clinically. When your patient with depression keeps
client doesn't know about — past client free-talk, watch what coming back to childhood abandonment stories, this is your
Freud (orig.) | Jung, conflicts, repressed feelings, early feelings they project onto you framework. Less couch-time, more here-and-now in
Erikson extended
trauma. as the therapist. psychodynamic version.
Adlerian (Individual) We're all driven by inferiority feelings Early recollections + Lifestyle Great for patients who feel 'less than' or stuck comparing
+ the need to belong. Behavior is assessment — ask about themselves to siblings/peers. Your patient who constantly seeks
Alfred Adler purposeful and goal-directed — not memories before age 10 and approval? Explore their birth order and private logic.
random. Birth order matters. family constellation to Encouragement is your most powerful tool here.
understand core beliefs.
Existential Four givens of existence: death, Authentic encounter — Patient facing cancer, end of life, major loss, or identity crisis?
freedom, isolation, meaninglessness. therapist is present and This is your go-to. Also powerful for patients asking 'why bother'
Yalom, Frankl, May People suffer when they can't face transparent, explores what the without meeting full SI criteria. Help them find meaning, not just
these realities. It's not a disease — patient avoids facing. symptom relief.
they're 'clumsy at living' (van
Deurzen).
Person-Centered The client already has the answers — Reflective listening + This is your foundation as a PMHNP — empathy is the #1
your job is creating the conditions for unconditional positive regard — predictor of patient progress (60 years of research). When a
Carl Rogers + Maslow growth. Three conditions: UPR + therapist reflects feelings back, patient feels truly heard, the therapeutic relationship IS the
congruence + empathy. never judges, never directs. intervention. Especially powerful with shame-heavy
Non-directive. presentations.
Gestalt Awareness in the present moment IS Empty chair technique + Patient processes grief by talking TO the empty chair as if their
the cure. People get stuck in here-and-now focus — keep the deceased parent is there. Powerful for patients who
Perls 'unfinished business' — interrupted patient in present experience, intellectualize instead of feel. 'What are you noticing in your body
contact with their experience or not storytelling about the past. right now?' is a classic Gestalt move.
environment.
COGNITIVE & BEHAVIORAL APPROACHES
CBT Thoughts, feelings, and behavior are Thought records + cognitive Your patient with MDD says 'I'm worthless.' CBT asks: what's the
all linked — change the thought, restructuring — identify the evidence FOR and AGAINST that? You work together like
Aaron Beck (cognitive) + change the feeling, change the automatic thought, examine the detectives challenging distorted thinking. Time-limited, works for
Bandura behavior. Present-focused, evidence, replace with balanced anxiety, depression, PTSD, eating disorders.
collaborative, structured. It's the thought.
workhorse.
REBT Irrational beliefs (especially the 3 ABCDE model — Dispute the Patient says 'Everyone MUST like me or I'm a failure.' REBT
'musts') are the root of emotional irrational belief vigorously, confronts that directly: 'Why must they? Where's the evidence?'
Albert Ellis — FIRST disturbance. A doesn't cause C — develop an Effective new More confrontational than CBT. Less warm relationship required.
cognitive therapy, your BELIEF about A causes C. You philosophy. Great for perfectionism and 'shoulding all over yourself.'
'grandfather of CBT'
must actively dispute, not just notice.
DBT Dialectic = acceptance AND change Distress tolerance + emotion Your BPD patient who burns bridges, self-harms, and goes from
at the same time. The patient's regulation skills — TIPP, DEAR idealization to devaluation overnight — DBT is the
Marsha Linehan — built environment was 'invalidating' — they MAN, radical acceptance. evidence-based answer. Also used for chronic suicidality.
for BPD never learned to regulate emotions. Validate the pain AND work to change the behavior
Skills training + individual therapy + simultaneously.
phone coaching.
Behavior Therapy Behavior is shaped by its Systematic desensitization Patient with panic disorder avoiding driving after an accident?
consequences, period. What gets (Wolpe) — pair relaxation with You build a fear hierarchy and work up from imagining the car to
Skinner (radical reinforced gets repeated. progressive exposure to feared sitting in it to driving around the block. Also use positive
behaviorism) + Wolpe + Observable, measurable, scientific. stimulus. reinforcement to build medication adherence in your med
Bandura
Not focused on insight. management role.
, Motivational Change happens when the patient OARS: Open questions, Your patient with bipolar who stopped their mood stabilizer
Interviewing talks themselves into it — not when Affirmations, Reflections, 'because it makes me feel flat.' You don't lecture — you ask:
you convince them. Roll with Summaries — evoke the 'What would life look like if you stayed stable?' and let them
Miller & Rollnick resistance. Ambivalence is normal. patient's own motivation. answer. Critical for med adherence, substance use, lifestyle
Short-term, empathic. changes.
INTERPERSONAL & SOLUTION-FOCUSED
IPT (Interpersonal Psychiatric disorders occur in an Interpersonal inventory + focus Patient with MDD after divorce? IPT maps exactly how that role
Therapy) interpersonal context. Depression is on one problem area — explore transition feeds depression. 3 phases: initial (identify problem
linked to relationship problems — current relationships, map the area), work (improve relationships), termination (consolidate
Klerman & Weissman grief, role disputes, role transitions, connection between mood and gains). Evidence-based for MDD specifically.
interpersonal deficits. Time-limited. relationships.
Solution-Focused You don't have to understand the Miracle question + exception Patient overwhelmed by depression who says 'nothing ever
Therapy problem to solve it. Focus on questions — 'If you woke up works.' Ask: 'Tell me about a day last week when it was even a
exceptions — when ISN'T the tomorrow and the problem was little bit better.' Especially useful in brief sessions or crisis work
de Shazer & Berg problem happening? Build on what gone, what would be different?' when you need a quick clinical win.
already works.
TRAUMA-FOCUSED APPROACHES
TRM / Resilient Zone The body knows before the brain Track body sensations — Your PTSD patient who dissociates or goes into rage during
does (bottom-up). The Resilient Zone patient learns to notice when sessions? They've left their RZ. You don't process trauma until
Elaine Miller-Karas (RZ) = window of tolerance — not too they're leaving their RZ and use they're stabilized in the RZ. 'Where do you feel that in your body
hyperaroused (sympathetic) or grounding/resourcing to return. right now?' is the gateway to this work.
hypoaroused (parasympathetic).
Vagus nerve is the highway.
EMDR Traumatic memories are stored as Bilateral stimulation during Your complex trauma patient who has tried CBT but keeps
fragmented sensory/somatic pieces trauma processing — patient getting flooded? EMDR may move stuck memories that talk
Shapiro — van der Kolk (not narrative). Bilateral stimulation holds target memory + negative therapy can't touch. Requires specific training — on your
advocates (eye movements) allows adaptive cognition while following eye PMHNP radar for referral or future skill.
reprocessing of those stuck movement; disturbance
memories. desensitizes.
CONFUSABLE PAIRS — The exam loves these
CBT vs REBT CBT = thoughts/feelings/behavior reciprocal; collaborative detective work. REBT = Ellis; irrational beliefs + 3 musts; ACTIVELY dispute; less warm
relationship needed. REBT is the PARENT — CBT came after.
Transference vs Transference = CLIENT projects past feelings onto YOU (therapist). Countertransference = YOUR unresolved stuff gets triggered by the client.
Countertransference Both are unconscious. Both must be managed. Exam trick: if the client starts reacting to you like a parent figure = transference.
Negative Negative reinforcement = REMOVES something bad to INCREASE behavior. (Taking off a wet sock = relief = you'll do whatever caused the
Reinforcement vs removal again.) Punishment = ADDS something bad (positive) OR REMOVES something good (negative) to DECREASE behavior. Negative
Punishment reinforcement always INCREASES behavior — this trips everyone up.
TRM vs CRM TRM (Trauma Resiliency Model) = individual/group therapy format; DOES process trauma; requires stabilization in RZ first. CRM (Community
Resiliency Model) = psychoeducation only; NOT therapy; does NOT process trauma; can be used in any setting with groups.
Systematic Systematic desensitization = GRADUAL exposure while relaxed; build a fear hierarchy, go step by step. Flooding = PROLONGED intense
Desensitization vs exposure all at once; no gradual; anxiety decreases on its own. Both are exposure therapy. Wolpe developed systematic desensitization
Flooding specifically.
Chapters 1–10 | Corey & Wheeler | Scan this while doing APEA practice Qs | You've got this.
How to use this: When a practice question gives you a vignette, ask yourself three things: (1) Is the therapist being directive or following the client? (2) Is the focus on
thoughts, feelings, behavior, or the relationship? (3) Is it past-focused (psychoanalytic) or present-focused (CBT/behavior/gestalt)? That narrows it to 2 options fast.
PSYCHODYNAMIC, HUMANISTIC & EXISTENTIAL APPROACHES
THEORY + FOUNDER THE ONE THING THAT MAKES IT KEY TECHNIQUE HOW YOU USE IT AS A PMHNP
DIFFERENT
Psychoanalytic / Unconscious drives run the show. Free association + Patient fixates on you or idealizes you? That's transference —
Psychodynamic Behavior is determined by stuff the Transference analysis — let the use it clinically. When your patient with depression keeps
client doesn't know about — past client free-talk, watch what coming back to childhood abandonment stories, this is your
Freud (orig.) | Jung, conflicts, repressed feelings, early feelings they project onto you framework. Less couch-time, more here-and-now in
Erikson extended
trauma. as the therapist. psychodynamic version.
Adlerian (Individual) We're all driven by inferiority feelings Early recollections + Lifestyle Great for patients who feel 'less than' or stuck comparing
+ the need to belong. Behavior is assessment — ask about themselves to siblings/peers. Your patient who constantly seeks
Alfred Adler purposeful and goal-directed — not memories before age 10 and approval? Explore their birth order and private logic.
random. Birth order matters. family constellation to Encouragement is your most powerful tool here.
understand core beliefs.
Existential Four givens of existence: death, Authentic encounter — Patient facing cancer, end of life, major loss, or identity crisis?
freedom, isolation, meaninglessness. therapist is present and This is your go-to. Also powerful for patients asking 'why bother'
Yalom, Frankl, May People suffer when they can't face transparent, explores what the without meeting full SI criteria. Help them find meaning, not just
these realities. It's not a disease — patient avoids facing. symptom relief.
they're 'clumsy at living' (van
Deurzen).
Person-Centered The client already has the answers — Reflective listening + This is your foundation as a PMHNP — empathy is the #1
your job is creating the conditions for unconditional positive regard — predictor of patient progress (60 years of research). When a
Carl Rogers + Maslow growth. Three conditions: UPR + therapist reflects feelings back, patient feels truly heard, the therapeutic relationship IS the
congruence + empathy. never judges, never directs. intervention. Especially powerful with shame-heavy
Non-directive. presentations.
Gestalt Awareness in the present moment IS Empty chair technique + Patient processes grief by talking TO the empty chair as if their
the cure. People get stuck in here-and-now focus — keep the deceased parent is there. Powerful for patients who
Perls 'unfinished business' — interrupted patient in present experience, intellectualize instead of feel. 'What are you noticing in your body
contact with their experience or not storytelling about the past. right now?' is a classic Gestalt move.
environment.
COGNITIVE & BEHAVIORAL APPROACHES
CBT Thoughts, feelings, and behavior are Thought records + cognitive Your patient with MDD says 'I'm worthless.' CBT asks: what's the
all linked — change the thought, restructuring — identify the evidence FOR and AGAINST that? You work together like
Aaron Beck (cognitive) + change the feeling, change the automatic thought, examine the detectives challenging distorted thinking. Time-limited, works for
Bandura behavior. Present-focused, evidence, replace with balanced anxiety, depression, PTSD, eating disorders.
collaborative, structured. It's the thought.
workhorse.
REBT Irrational beliefs (especially the 3 ABCDE model — Dispute the Patient says 'Everyone MUST like me or I'm a failure.' REBT
'musts') are the root of emotional irrational belief vigorously, confronts that directly: 'Why must they? Where's the evidence?'
Albert Ellis — FIRST disturbance. A doesn't cause C — develop an Effective new More confrontational than CBT. Less warm relationship required.
cognitive therapy, your BELIEF about A causes C. You philosophy. Great for perfectionism and 'shoulding all over yourself.'
'grandfather of CBT'
must actively dispute, not just notice.
DBT Dialectic = acceptance AND change Distress tolerance + emotion Your BPD patient who burns bridges, self-harms, and goes from
at the same time. The patient's regulation skills — TIPP, DEAR idealization to devaluation overnight — DBT is the
Marsha Linehan — built environment was 'invalidating' — they MAN, radical acceptance. evidence-based answer. Also used for chronic suicidality.
for BPD never learned to regulate emotions. Validate the pain AND work to change the behavior
Skills training + individual therapy + simultaneously.
phone coaching.
Behavior Therapy Behavior is shaped by its Systematic desensitization Patient with panic disorder avoiding driving after an accident?
consequences, period. What gets (Wolpe) — pair relaxation with You build a fear hierarchy and work up from imagining the car to
Skinner (radical reinforced gets repeated. progressive exposure to feared sitting in it to driving around the block. Also use positive
behaviorism) + Wolpe + Observable, measurable, scientific. stimulus. reinforcement to build medication adherence in your med
Bandura
Not focused on insight. management role.
, Motivational Change happens when the patient OARS: Open questions, Your patient with bipolar who stopped their mood stabilizer
Interviewing talks themselves into it — not when Affirmations, Reflections, 'because it makes me feel flat.' You don't lecture — you ask:
you convince them. Roll with Summaries — evoke the 'What would life look like if you stayed stable?' and let them
Miller & Rollnick resistance. Ambivalence is normal. patient's own motivation. answer. Critical for med adherence, substance use, lifestyle
Short-term, empathic. changes.
INTERPERSONAL & SOLUTION-FOCUSED
IPT (Interpersonal Psychiatric disorders occur in an Interpersonal inventory + focus Patient with MDD after divorce? IPT maps exactly how that role
Therapy) interpersonal context. Depression is on one problem area — explore transition feeds depression. 3 phases: initial (identify problem
linked to relationship problems — current relationships, map the area), work (improve relationships), termination (consolidate
Klerman & Weissman grief, role disputes, role transitions, connection between mood and gains). Evidence-based for MDD specifically.
interpersonal deficits. Time-limited. relationships.
Solution-Focused You don't have to understand the Miracle question + exception Patient overwhelmed by depression who says 'nothing ever
Therapy problem to solve it. Focus on questions — 'If you woke up works.' Ask: 'Tell me about a day last week when it was even a
exceptions — when ISN'T the tomorrow and the problem was little bit better.' Especially useful in brief sessions or crisis work
de Shazer & Berg problem happening? Build on what gone, what would be different?' when you need a quick clinical win.
already works.
TRAUMA-FOCUSED APPROACHES
TRM / Resilient Zone The body knows before the brain Track body sensations — Your PTSD patient who dissociates or goes into rage during
does (bottom-up). The Resilient Zone patient learns to notice when sessions? They've left their RZ. You don't process trauma until
Elaine Miller-Karas (RZ) = window of tolerance — not too they're leaving their RZ and use they're stabilized in the RZ. 'Where do you feel that in your body
hyperaroused (sympathetic) or grounding/resourcing to return. right now?' is the gateway to this work.
hypoaroused (parasympathetic).
Vagus nerve is the highway.
EMDR Traumatic memories are stored as Bilateral stimulation during Your complex trauma patient who has tried CBT but keeps
fragmented sensory/somatic pieces trauma processing — patient getting flooded? EMDR may move stuck memories that talk
Shapiro — van der Kolk (not narrative). Bilateral stimulation holds target memory + negative therapy can't touch. Requires specific training — on your
advocates (eye movements) allows adaptive cognition while following eye PMHNP radar for referral or future skill.
reprocessing of those stuck movement; disturbance
memories. desensitizes.
CONFUSABLE PAIRS — The exam loves these
CBT vs REBT CBT = thoughts/feelings/behavior reciprocal; collaborative detective work. REBT = Ellis; irrational beliefs + 3 musts; ACTIVELY dispute; less warm
relationship needed. REBT is the PARENT — CBT came after.
Transference vs Transference = CLIENT projects past feelings onto YOU (therapist). Countertransference = YOUR unresolved stuff gets triggered by the client.
Countertransference Both are unconscious. Both must be managed. Exam trick: if the client starts reacting to you like a parent figure = transference.
Negative Negative reinforcement = REMOVES something bad to INCREASE behavior. (Taking off a wet sock = relief = you'll do whatever caused the
Reinforcement vs removal again.) Punishment = ADDS something bad (positive) OR REMOVES something good (negative) to DECREASE behavior. Negative
Punishment reinforcement always INCREASES behavior — this trips everyone up.
TRM vs CRM TRM (Trauma Resiliency Model) = individual/group therapy format; DOES process trauma; requires stabilization in RZ first. CRM (Community
Resiliency Model) = psychoeducation only; NOT therapy; does NOT process trauma; can be used in any setting with groups.
Systematic Systematic desensitization = GRADUAL exposure while relaxed; build a fear hierarchy, go step by step. Flooding = PROLONGED intense
Desensitization vs exposure all at once; no gradual; anxiety decreases on its own. Both are exposure therapy. Wolpe developed systematic desensitization
Flooding specifically.
