WILKES NSG 526 EXAM 4 2026/2027 - CLINICAL MODALITIES ADVANCED PSYCH | SUBSTANCE
USE, STAGES OF CHANGE, SOLUTION-FOCUSED | Q&A; | A+ GRADED
Course: WILKES NSG 526 Clinical Modalities Advanced Psych | 350Q Mixed: A=96 B=94 C=82 D=78 | 2026/2027 Bundle |
Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy
Original 2026/2027 content for Wilkes NSG 526 - Advanced Psych Clinical Modalities. Based on DSM-5-TR, Wheeler Psychotherapy, Stahl Psychopharmacology. Mixed A/B/C/D keys.
For study purposes.
1. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Cultural humility vs competence? (Case 1)
A. Humility lifelong learning, self-reflection, partnership - not assuming competence - avoid stereotyping
B. Competence assumes mastery
C. No humility
D. Same as stereotyping
Answer: A
Explanation: Cultural humility ongoing self-reflection, partnership.
2. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Which therapy modality is best for client with BPD
and self-harm - intense fear of abandonment? (Case 2)
A. Dialectical Behavior Therapy (DBT) - distress tolerance, emotion regulation, interpersonal effectiveness, mindfulness
B. Psychoanalysis only
C. Supportive therapy only
D. No therapy
Answer: A
Explanation: DBT is gold standard for BPD, self-harm, emotion dysregulation. Skills: distress tolerance, emotion regulation, interpersonal
effectiveness, mindfulness.
3. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Cultural humility vs competence? (Case 3)
A. Humility lifelong learning, self-reflection, partnership - not assuming competence - avoid stereotyping
B. Competence assumes mastery
C. Same as stereotyping
D. No humility
Answer: A
Explanation: Cultural humility ongoing self-reflection, partnership.
4. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Motivational Interviewing principle OARS? (Case 4)
A. Confrontation
B. Open questions, Affirmations, Reflective listening, Summaries - stages of change pre-contemplation to maintenance
C. Closed questions only
D. No principle
Answer: B
Explanation: MI OARS: Open questions, Affirmations, Reflective listening, Summaries. Roll with resistance, avoid argumentation.
5. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Atypical antipsychotic - metabolic syndrome
monitoring? (Case 5)
A. No monitoring
B. Only weight
C. No labs
D. Weight, BMI, waist, BP, glucose/HbA1c, lipids, EPS, TD via AIMS - clozapine agranulocytosis ANC
Answer: D
Explanation: Atypicals: metabolic syndrome - weight, BP, glucose, lipids. EPS, TD. Clozapine agranulocytosis needs ANC.
6. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Narrative therapy - externalization? (Case 6)
A. Externalize problem - person is not problem, problem is problem - re-author story
B. No externalization
C. Internalize problem
D. Blame person
Answer: A
Explanation: Narrative externalization: problem separate from person.
7. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Narrative therapy - externalization? (Case 7)
A. No externalization
B. Internalize problem
C. Blame person
D. Externalize problem - person is not problem, problem is problem - re-author story
Answer: D
Explanation: Narrative externalization: problem separate from person.
,8. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Solution-Focused Brief Therapy (SFBT) - miracle
question? (Case 8)
A. No solution
B. No question
C. Past focused only
D. Miracle question: If miracle happened tonight problem solved, what would be different? Scaling questions, exceptions
Answer: D
Explanation: SFBT miracle question, scaling 0-10, exceptions when problem not present, future-oriented.
9. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Family therapy structural - Minuchin - focuses on?
(Case 9)
A. Family structure, subsystems, boundaries, enmeshment/disengagement, join and enact
B. No focus
C. Only child
D. Individual only
Answer: A
Explanation: Structural family therapy: structure, subsystems (parental, sibling), boundaries clear/diffuse/rigid, enmeshment vs disengagement.
10. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Exposure and Response Prevention (ERP) is
first-line for? (Case 10)
A. Mania
B. OCD - exposure to feared stimuli without ritual, habituation
C. Schizophrenia
D. Depression
Answer: B
Explanation: ERP for OCD: exposure to obsessions without compulsions, prevents negative reinforcement.
11. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Which therapy modality is best for client with BPD
and self-harm - intense fear of abandonment? (Case 11)
A. Dialectical Behavior Therapy (DBT) - distress tolerance, emotion regulation, interpersonal effectiveness, mindfulness
B. No therapy
C. Psychoanalysis only
D. Supportive therapy only
Answer: A
Explanation: DBT is gold standard for BPD, self-harm, emotion dysregulation. Skills: distress tolerance, emotion regulation, interpersonal
effectiveness, mindfulness.
12. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Benzodiazepine long-term risks? (Case 12)
A. No dependence
B. Safe long-term
C. Dependence, tolerance, falls in elderly, cognitive impairment, withdrawal seizures - taper slowly
D. No risks
Answer: C
Explanation: Benzos dependence, tolerance, falls, cognitive decline, withdrawal seizures - short-term use, taper.
13. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Trauma-informed care principles? (Case 13)
A. Force exposure
B. Safety, trustworthiness, peer support, collaboration, empowerment, cultural issues - avoid re-traumatization
C. No principles
D. Confront trauma directly
Answer: B
Explanation: Trauma-informed: safety, trust, peer support, collaboration, empowerment, cultural sensitivity.
14. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Psychodynamic therapy transference means? (Case
14)
A. No meaning
B. Client projects feelings from past relationships onto therapist - analyze countertransference
C. No transference
D. Therapist projects
Answer: B
Explanation: Transference client projects past onto therapist, countertransference therapist projects onto client - must be analyzed.
15. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Interpersonal Therapy (IPT) for depression - 4
problem areas? (Case 15)
A. Only role
B. No areas
C. Grief, role transition, role dispute, interpersonal deficits
D. Only grief
,Answer: C
Explanation: IPT 4 areas: grief, role transition, role dispute, interpersonal deficits.
16. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Pharmacology - SSRI first-line for depression -
onset? (Case 16)
A. No onset
B. 2-4 weeks full effect, watch for increased suicidal ideation in adolescents/young adults early
C. Immediate
D. 1 hour
Answer: B
Explanation: SSRI 2-4 weeks, black box warning increased suicidality early in youth.
17. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Interpersonal Therapy (IPT) for depression - 4
problem areas? (Case 17)
A. Only role
B. Grief, role transition, role dispute, interpersonal deficits
C. No areas
D. Only grief
Answer: B
Explanation: IPT 4 areas: grief, role transition, role dispute, interpersonal deficits.
18. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Cultural humility vs competence? (Case 18)
A. No humility
B. Competence assumes mastery
C. Humility lifelong learning, self-reflection, partnership - not assuming competence - avoid stereotyping
D. Same as stereotyping
Answer: C
Explanation: Cultural humility ongoing self-reflection, partnership.
19. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Psychodynamic therapy transference means? (Case
19)
A. Client projects feelings from past relationships onto therapist - analyze countertransference
B. No transference
C. Therapist projects
D. No meaning
Answer: A
Explanation: Transference client projects past onto therapist, countertransference therapist projects onto client - must be analyzed.
20. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Which therapy modality is best for client with BPD
and self-harm - intense fear of abandonment? (Case 20)
A. Supportive therapy only
B. Psychoanalysis only
C. No therapy
D. Dialectical Behavior Therapy (DBT) - distress tolerance, emotion regulation, interpersonal effectiveness, mindfulness
Answer: D
Explanation: DBT is gold standard for BPD, self-harm, emotion dysregulation. Skills: distress tolerance, emotion regulation, interpersonal
effectiveness, mindfulness.
21. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Atypical antipsychotic - metabolic syndrome
monitoring? (Case 21)
A. No labs
B. No monitoring
C. Only weight
D. Weight, BMI, waist, BP, glucose/HbA1c, lipids, EPS, TD via AIMS - clozapine agranulocytosis ANC
Answer: D
Explanation: Atypicals: metabolic syndrome - weight, BP, glucose, lipids. EPS, TD. Clozapine agranulocytosis needs ANC.
22. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Substance use - Stages of Change -
pre-contemplation? (Case 22)
A. Not yet acknowledging problem - no intent to change in 6 months - use MI to build discrepancy
B. Action
C. Preparation
D. Maintenance
Answer: A
Explanation: Pre-contemplation no awareness, contemplation ambivalent, preparation ready, action change, maintenance sustain.
23. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Benzodiazepine long-term risks? (Case 23)
A. Dependence, tolerance, falls in elderly, cognitive impairment, withdrawal seizures - taper slowly
B. No dependence
, C. No risks
D. Safe long-term
Answer: A
Explanation: Benzos dependence, tolerance, falls, cognitive decline, withdrawal seizures - short-term use, taper.
24. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] EMDR phases - for PTSD? (Case 24)
A. No phases
B. 8 phases: history, preparation, assessment, desensitization, installation, body scan, closure, reevaluation - bilateral stimulation
C. No use
D. Only 1 phase
Answer: B
Explanation: EMDR for trauma: 8 phases with bilateral stimulation to reprocess traumatic memories.
25. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Family therapy structural - Minuchin - focuses on?
(Case 25)
A. Family structure, subsystems, boundaries, enmeshment/disengagement, join and enact
B. No focus
C. Only child
D. Individual only
Answer: A
Explanation: Structural family therapy: structure, subsystems (parental, sibling), boundaries clear/diffuse/rigid, enmeshment vs disengagement.
26. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] EMDR phases - for PTSD? (Case 26)
A. No use
B. No phases
C. Only 1 phase
D. 8 phases: history, preparation, assessment, desensitization, installation, body scan, closure, reevaluation - bilateral stimulation
Answer: D
Explanation: EMDR for trauma: 8 phases with bilateral stimulation to reprocess traumatic memories.
27. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Substance use - Stages of Change -
pre-contemplation? (Case 27)
A. Maintenance
B. Not yet acknowledging problem - no intent to change in 6 months - use MI to build discrepancy
C. Action
D. Preparation
Answer: B
Explanation: Pre-contemplation no awareness, contemplation ambivalent, preparation ready, action change, maintenance sustain.
28. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Pharmacology - SSRI first-line for depression -
onset? (Case 28)
A. 1 hour
B. 2-4 weeks full effect, watch for increased suicidal ideation in adolescents/young adults early
C. No onset
D. Immediate
Answer: B
Explanation: SSRI 2-4 weeks, black box warning increased suicidality early in youth.
29. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Mental Status Exam - thought content vs process?
(Case 29)
A. Only content
B. Content what client thinks (delusions, SI/HI), Process how thoughts flow (loose, tangential, circumstantial, flight)
C. Same
D. No difference
Answer: B
Explanation: Thought content delusions/SI/HI, process loose associations, tangential, circumstantial.
30. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Motivational Interviewing principle OARS? (Case 30)
A. Confrontation
B. Open questions, Affirmations, Reflective listening, Summaries - stages of change pre-contemplation to maintenance
C. Closed questions only
D. No principle
Answer: B
Explanation: MI OARS: Open questions, Affirmations, Reflective listening, Summaries. Roll with resistance, avoid argumentation.
31. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Solution-Focused Brief Therapy (SFBT) - miracle
question? (Case 31)
A. Miracle question: If miracle happened tonight problem solved, what would be different? Scaling questions, exceptions
USE, STAGES OF CHANGE, SOLUTION-FOCUSED | Q&A; | A+ GRADED
Course: WILKES NSG 526 Clinical Modalities Advanced Psych | 350Q Mixed: A=96 B=94 C=82 D=78 | 2026/2027 Bundle |
Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy
Original 2026/2027 content for Wilkes NSG 526 - Advanced Psych Clinical Modalities. Based on DSM-5-TR, Wheeler Psychotherapy, Stahl Psychopharmacology. Mixed A/B/C/D keys.
For study purposes.
1. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Cultural humility vs competence? (Case 1)
A. Humility lifelong learning, self-reflection, partnership - not assuming competence - avoid stereotyping
B. Competence assumes mastery
C. No humility
D. Same as stereotyping
Answer: A
Explanation: Cultural humility ongoing self-reflection, partnership.
2. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Which therapy modality is best for client with BPD
and self-harm - intense fear of abandonment? (Case 2)
A. Dialectical Behavior Therapy (DBT) - distress tolerance, emotion regulation, interpersonal effectiveness, mindfulness
B. Psychoanalysis only
C. Supportive therapy only
D. No therapy
Answer: A
Explanation: DBT is gold standard for BPD, self-harm, emotion dysregulation. Skills: distress tolerance, emotion regulation, interpersonal
effectiveness, mindfulness.
3. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Cultural humility vs competence? (Case 3)
A. Humility lifelong learning, self-reflection, partnership - not assuming competence - avoid stereotyping
B. Competence assumes mastery
C. Same as stereotyping
D. No humility
Answer: A
Explanation: Cultural humility ongoing self-reflection, partnership.
4. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Motivational Interviewing principle OARS? (Case 4)
A. Confrontation
B. Open questions, Affirmations, Reflective listening, Summaries - stages of change pre-contemplation to maintenance
C. Closed questions only
D. No principle
Answer: B
Explanation: MI OARS: Open questions, Affirmations, Reflective listening, Summaries. Roll with resistance, avoid argumentation.
5. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Atypical antipsychotic - metabolic syndrome
monitoring? (Case 5)
A. No monitoring
B. Only weight
C. No labs
D. Weight, BMI, waist, BP, glucose/HbA1c, lipids, EPS, TD via AIMS - clozapine agranulocytosis ANC
Answer: D
Explanation: Atypicals: metabolic syndrome - weight, BP, glucose, lipids. EPS, TD. Clozapine agranulocytosis needs ANC.
6. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Narrative therapy - externalization? (Case 6)
A. Externalize problem - person is not problem, problem is problem - re-author story
B. No externalization
C. Internalize problem
D. Blame person
Answer: A
Explanation: Narrative externalization: problem separate from person.
7. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Narrative therapy - externalization? (Case 7)
A. No externalization
B. Internalize problem
C. Blame person
D. Externalize problem - person is not problem, problem is problem - re-author story
Answer: D
Explanation: Narrative externalization: problem separate from person.
,8. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Solution-Focused Brief Therapy (SFBT) - miracle
question? (Case 8)
A. No solution
B. No question
C. Past focused only
D. Miracle question: If miracle happened tonight problem solved, what would be different? Scaling questions, exceptions
Answer: D
Explanation: SFBT miracle question, scaling 0-10, exceptions when problem not present, future-oriented.
9. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Family therapy structural - Minuchin - focuses on?
(Case 9)
A. Family structure, subsystems, boundaries, enmeshment/disengagement, join and enact
B. No focus
C. Only child
D. Individual only
Answer: A
Explanation: Structural family therapy: structure, subsystems (parental, sibling), boundaries clear/diffuse/rigid, enmeshment vs disengagement.
10. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Exposure and Response Prevention (ERP) is
first-line for? (Case 10)
A. Mania
B. OCD - exposure to feared stimuli without ritual, habituation
C. Schizophrenia
D. Depression
Answer: B
Explanation: ERP for OCD: exposure to obsessions without compulsions, prevents negative reinforcement.
11. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Which therapy modality is best for client with BPD
and self-harm - intense fear of abandonment? (Case 11)
A. Dialectical Behavior Therapy (DBT) - distress tolerance, emotion regulation, interpersonal effectiveness, mindfulness
B. No therapy
C. Psychoanalysis only
D. Supportive therapy only
Answer: A
Explanation: DBT is gold standard for BPD, self-harm, emotion dysregulation. Skills: distress tolerance, emotion regulation, interpersonal
effectiveness, mindfulness.
12. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Benzodiazepine long-term risks? (Case 12)
A. No dependence
B. Safe long-term
C. Dependence, tolerance, falls in elderly, cognitive impairment, withdrawal seizures - taper slowly
D. No risks
Answer: C
Explanation: Benzos dependence, tolerance, falls, cognitive decline, withdrawal seizures - short-term use, taper.
13. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Trauma-informed care principles? (Case 13)
A. Force exposure
B. Safety, trustworthiness, peer support, collaboration, empowerment, cultural issues - avoid re-traumatization
C. No principles
D. Confront trauma directly
Answer: B
Explanation: Trauma-informed: safety, trust, peer support, collaboration, empowerment, cultural sensitivity.
14. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Psychodynamic therapy transference means? (Case
14)
A. No meaning
B. Client projects feelings from past relationships onto therapist - analyze countertransference
C. No transference
D. Therapist projects
Answer: B
Explanation: Transference client projects past onto therapist, countertransference therapist projects onto client - must be analyzed.
15. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Interpersonal Therapy (IPT) for depression - 4
problem areas? (Case 15)
A. Only role
B. No areas
C. Grief, role transition, role dispute, interpersonal deficits
D. Only grief
,Answer: C
Explanation: IPT 4 areas: grief, role transition, role dispute, interpersonal deficits.
16. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Pharmacology - SSRI first-line for depression -
onset? (Case 16)
A. No onset
B. 2-4 weeks full effect, watch for increased suicidal ideation in adolescents/young adults early
C. Immediate
D. 1 hour
Answer: B
Explanation: SSRI 2-4 weeks, black box warning increased suicidality early in youth.
17. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Interpersonal Therapy (IPT) for depression - 4
problem areas? (Case 17)
A. Only role
B. Grief, role transition, role dispute, interpersonal deficits
C. No areas
D. Only grief
Answer: B
Explanation: IPT 4 areas: grief, role transition, role dispute, interpersonal deficits.
18. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Cultural humility vs competence? (Case 18)
A. No humility
B. Competence assumes mastery
C. Humility lifelong learning, self-reflection, partnership - not assuming competence - avoid stereotyping
D. Same as stereotyping
Answer: C
Explanation: Cultural humility ongoing self-reflection, partnership.
19. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Psychodynamic therapy transference means? (Case
19)
A. Client projects feelings from past relationships onto therapist - analyze countertransference
B. No transference
C. Therapist projects
D. No meaning
Answer: A
Explanation: Transference client projects past onto therapist, countertransference therapist projects onto client - must be analyzed.
20. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Which therapy modality is best for client with BPD
and self-harm - intense fear of abandonment? (Case 20)
A. Supportive therapy only
B. Psychoanalysis only
C. No therapy
D. Dialectical Behavior Therapy (DBT) - distress tolerance, emotion regulation, interpersonal effectiveness, mindfulness
Answer: D
Explanation: DBT is gold standard for BPD, self-harm, emotion dysregulation. Skills: distress tolerance, emotion regulation, interpersonal
effectiveness, mindfulness.
21. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Atypical antipsychotic - metabolic syndrome
monitoring? (Case 21)
A. No labs
B. No monitoring
C. Only weight
D. Weight, BMI, waist, BP, glucose/HbA1c, lipids, EPS, TD via AIMS - clozapine agranulocytosis ANC
Answer: D
Explanation: Atypicals: metabolic syndrome - weight, BP, glucose, lipids. EPS, TD. Clozapine agranulocytosis needs ANC.
22. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Substance use - Stages of Change -
pre-contemplation? (Case 22)
A. Not yet acknowledging problem - no intent to change in 6 months - use MI to build discrepancy
B. Action
C. Preparation
D. Maintenance
Answer: A
Explanation: Pre-contemplation no awareness, contemplation ambivalent, preparation ready, action change, maintenance sustain.
23. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Benzodiazepine long-term risks? (Case 23)
A. Dependence, tolerance, falls in elderly, cognitive impairment, withdrawal seizures - taper slowly
B. No dependence
, C. No risks
D. Safe long-term
Answer: A
Explanation: Benzos dependence, tolerance, falls, cognitive decline, withdrawal seizures - short-term use, taper.
24. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] EMDR phases - for PTSD? (Case 24)
A. No phases
B. 8 phases: history, preparation, assessment, desensitization, installation, body scan, closure, reevaluation - bilateral stimulation
C. No use
D. Only 1 phase
Answer: B
Explanation: EMDR for trauma: 8 phases with bilateral stimulation to reprocess traumatic memories.
25. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Family therapy structural - Minuchin - focuses on?
(Case 25)
A. Family structure, subsystems, boundaries, enmeshment/disengagement, join and enact
B. No focus
C. Only child
D. Individual only
Answer: A
Explanation: Structural family therapy: structure, subsystems (parental, sibling), boundaries clear/diffuse/rigid, enmeshment vs disengagement.
26. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] EMDR phases - for PTSD? (Case 26)
A. No use
B. No phases
C. Only 1 phase
D. 8 phases: history, preparation, assessment, desensitization, installation, body scan, closure, reevaluation - bilateral stimulation
Answer: D
Explanation: EMDR for trauma: 8 phases with bilateral stimulation to reprocess traumatic memories.
27. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Substance use - Stages of Change -
pre-contemplation? (Case 27)
A. Maintenance
B. Not yet acknowledging problem - no intent to change in 6 months - use MI to build discrepancy
C. Action
D. Preparation
Answer: B
Explanation: Pre-contemplation no awareness, contemplation ambivalent, preparation ready, action change, maintenance sustain.
28. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Pharmacology - SSRI first-line for depression -
onset? (Case 28)
A. 1 hour
B. 2-4 weeks full effect, watch for increased suicidal ideation in adolescents/young adults early
C. No onset
D. Immediate
Answer: B
Explanation: SSRI 2-4 weeks, black box warning increased suicidality early in youth.
29. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Mental Status Exam - thought content vs process?
(Case 29)
A. Only content
B. Content what client thinks (delusions, SI/HI), Process how thoughts flow (loose, tangential, circumstantial, flight)
C. Same
D. No difference
Answer: B
Explanation: Thought content delusions/SI/HI, process loose associations, tangential, circumstantial.
30. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Motivational Interviewing principle OARS? (Case 30)
A. Confrontation
B. Open questions, Affirmations, Reflective listening, Summaries - stages of change pre-contemplation to maintenance
C. Closed questions only
D. No principle
Answer: B
Explanation: MI OARS: Open questions, Affirmations, Reflective listening, Summaries. Roll with resistance, avoid argumentation.
31. [Exam 4: Substance Use, Stages of Change, Solution-Focused, Narrative Therapy] Solution-Focused Brief Therapy (SFBT) - miracle
question? (Case 31)
A. Miracle question: If miracle happened tonight problem solved, what would be different? Scaling questions, exceptions
