Counseling theories and techniques, the rehabilitation angle

In integrated dual disorder treatment, a client with schizophrenia now keeps his appointments and trusts his team, but he does not see his daily drinking as a problem. The counselor's main task at this stage is to:

1. build his motivation to cut down
   He is engaged but not yet convinced, which is the persuasion stage; the work is helping him see how drinking affects his own goals so he wants to change.
2. keep up outreach to engage him
   Outreach to win his trust is the engagement stage, and he already attends and trusts the team.
3. teach relapse prevention skills
   Relapse prevention comes after a period of reduced use or abstinence; he does not yet see drinking as a problem.
4. require abstinence before services
   Integrated treatment does not make sobriety a condition of services; demanding it would likely end his engagement.

Two weeks after an amputation, a roofer insists he will be back on roofs next month and refuses to discuss any alternatives. In psychoanalytic terms, he is MOST likely using:

1. rationalization.
   Rationalization offers a plausible excuse for an outcome; he is not explaining anything away, he is refusing to accept it.
2. sublimation.
   Sublimation channels impulses into socially valued activity; refusing to discuss alternatives is not that.
3. denial.
   Refusing to accept the reality or permanence of the loss is denial, common early in adjustment to a sudden disability.
4. projection.
   Projection attributes one's own unacceptable feelings to others, which is not what he is doing.

A client with a mild intellectual disability sorts parts by size and type accurately but struggles to reason about hypothetical 'what if' job situations. This pattern matches Piaget's:

1. formal operational stage.
   Formal operational thinking is the ability to reason about hypotheticals, exactly what this client struggles with.
2. sensorimotor stage.
   The sensorimotor stage is infant thinking through action and the senses, far below the sorting skill shown.
3. intuitive preoperational stage.
   Preoperational thinkers have trouble classifying by more than one attribute; accurate sorting by size and type is beyond that stage.
4. concrete operational stage.
   Concrete operational thinking handles classification and logic about real objects but struggles with hypotheticals, which matches sorting parts well and stumbling on 'what if' questions.

A client facing eviction and skipping meals shows little interest in the career exploration his counselor planned. Drawing on Maslow, the counselor should FIRST help address:

1. esteem needs through a strengths inventory.
   Esteem sits higher in the hierarchy; working on it while he is hungry and facing eviction reverses Maslow's order.
2. basic physiological and safety needs.
   In Maslow's hierarchy, food and housing come before higher needs, so career exploration waits until the eviction and missed meals are addressed.
3. self-actualization via values work.
   Self-actualization is the top of the hierarchy, the least relevant level for a client without secure food or housing.
4. belonging needs via a peer group.
   Belonging is the level above safety; a peer group does not meet his immediate need for food and shelter.

A 9-year-old with a learning disability, after repeated failure with reading, begins calling himself 'dumb at everything.' Erikson would say he is struggling with:

1. autonomy vs. shame and doubt.
   Autonomy vs. shame and doubt is the toddler stage, centered on self-control and independence.
2. identity vs. role confusion.
   Identity vs. role confusion begins in adolescence; a 9-year-old is still in the school-age stage.
3. initiative vs. guilt.
   Initiative vs. guilt is the preschool stage (about ages 3 to 5), centered on starting activities, not on competence at schoolwork.
4. industry vs. inferiority.
   Industry vs. inferiority is Erikson's school-age crisis (about ages 6 to 12): repeated failure at school tasks can produce a sense of inferiority, such as 'dumb at everything.'

After one negative performance review, a client says, "I mess up everything I do at work." In Beck's terms, this distortion is BEST labeled:

1. personalization.
   Personalization means blaming oneself for events one did not cause; the review is about his own work, so he is overgeneralizing it.
2. emotional reasoning.
   Emotional reasoning treats a feeling as proof, as in 'I feel incompetent, so I am'; this client reasons from one event, not from a feeling.
3. overgeneralization.
   Overgeneralization turns one negative event into a sweeping pattern, as in 'everything I do' after a single review.
4. catastrophizing.
   Catastrophizing predicts the worst possible outcome; he is not predicting a disaster, he is turning one review into a rule about all his work.

A client believes that asking for a minor accommodation will get him fired. He and the counselor plan for him to ask and record what actually happens. This CBT technique is a:

1. graded exposure hierarchy.
   A graded exposure hierarchy ranks feared situations to face step by step to reduce anxiety; a single planned test of a prediction is a behavioral experiment.
2. decatastrophizing script.
   Decatastrophizing examines the worst case and how he would cope with it in session; it does not test the belief through action.
3. thought record.
   A thought record logs situations, thoughts, and feelings on paper; nothing is tested in the real world.
4. behavioral experiment.
   A behavioral experiment tests a belief in real life: he makes the request and records what happens to see whether his prediction comes true.

In a treatment plan, "Client will attend four job club sessions by March 31" is an example of:

1. an intervention.
   An intervention is what the counselor does, such as running the job club, not the client's measurable target.
2. a problem statement.
   A problem statement describes the difficulty, such as unemployment, not a planned action with a deadline.
3. a goal.
   A goal is the broader aim, such as getting a job; attending four sessions by a date is a measurable step toward it.
4. an objective.
   An objective is a specific, measurable, time-limited step toward a goal: four sessions by March 31.

A client with chronic back pain has attended physical therapy consistently for the past two months and reports less pain. According to the transtheoretical model, she is in the:

1. action stage.
   Action is the stage of actively changing behavior for less than about six months; two months of steady physical therapy fits.
2. contemplation stage.
   Contemplation means thinking about change without acting; she has been acting for two months.
3. maintenance stage.
   Maintenance starts after about six months of sustained change; two months is too early.
4. preparation stage.
   Preparation means intending to act soon and taking small steps; she is already attending consistently.

A counselor builds a client's plan around her interests, talents, and community resources rather than her deficits. This approach reflects:

1. the moral model.
   The moral model treats disability as shame or punishment; it says nothing about building plans on strengths.
2. the strengths model.
   The strengths model builds plans from the person's interests, talents, and community resources instead of starting from deficits.
3. the medical model.
   The medical model focuses on diagnosing and treating impairments, which is deficit-centered.
4. the functional limitations model.
   The functional limitations model starts from what the person cannot do and tries to fix it, which is the opposite of the stem.

A client who drinks heavily every day tells her counselor she plans to stop drinking completely tomorrow. The counselor's FIRST priority is to:

1. arrange a medical withdrawal-risk check.
   Stopping heavy daily drinking abruptly can cause dangerous withdrawal, including seizures and delirium tremens, so a medical check for supervised withdrawal comes first.
2. refer her to Alcoholics Anonymous.
   Mutual-help groups support recovery, but they do not manage the medical risk of stopping suddenly.
3. strengthen her commitment with MI.
   Her motivation is already high, and strengthening commitment does nothing about the physical danger of quitting abruptly.
4. begin relapse prevention planning.
   Relapse prevention matters later; before that, she has to get through withdrawal safely.

Research in state VR programs found that which factor within counseling is MOST related to clients' employment outcomes?

1. The number of sessions attended
   More contacts do not guarantee better outcomes; the quality of the alliance predicts them better.
2. The counselor's orientation
   Theoretical orientation predicts outcomes poorly compared with relationship factors such as the alliance.
3. The strength of the working alliance
   Studies of state VR clients (for example, Lustig and colleagues) found that a stronger working alliance was associated with better employment outcomes.
4. The counselor's years of experience
   Experience alone has shown weak links to client outcomes; what happens within the relationship matters more.

A client taking prescribed opioids exactly as directed develops tolerance and withdrawal. For a DSM-5-TR opioid use disorder diagnosis, these symptoms:

1. count as two of the criteria.
   Counting them would label expected effects of appropriate pain treatment as a disorder, which DSM-5-TR specifically rules out.
2. indicate a severe disorder.
   Severity depends on the number of criteria met (6 or more for severe); these two do not count at all here.
3. are not counted.
   DSM-5-TR does not count tolerance and withdrawal toward opioid use disorder when the medication is taken as prescribed under medical supervision.
4. alone establish a mild disorder.
   A mild disorder needs 2 to 3 qualifying criteria, and tolerance and withdrawal under supervised use are excluded, so they cannot establish one.

Person-centered planning tools such as MAPS and PATH are used primarily to:

1. rank job matches using aptitude test results.
   Ranking job matches by test scores is a trait-factor method, while MAPS and PATH are group planning processes.
2. set goals from the individual's own vision and supports.
   MAPS and PATH bring the person and people who know them together to describe the person's dreams and plan concrete steps toward them.
3. determine eligibility for VR or waiver services.
   Eligibility decisions rest on agency criteria and records; person-centered planning tools do not screen people in or out.
4. measure functional limitations for benefits.
   Measuring limitations for benefits is a deficit-focused task; MAPS and PATH start from the person's gifts and goals.

The primary aim of acceptance and commitment therapy (ACT) for a client with chronic pain is to:

1. replace catastrophic thoughts about pain.
   Replacing thoughts is cognitive restructuring from CBT; ACT changes one's relationship to thoughts through defusion instead.
2. reduce pain intensity through relaxation.
   Reducing pain intensity is not ACT's aim; relaxation is a different, control-based technique.
3. eliminate pain-related fear through exposure.
   Exposure aimed at eliminating fear belongs to fear-avoidance treatments; ACT does not try to remove feelings.
4. increase valued living despite pain.
   ACT aims for psychological flexibility: accepting pain and acting on personal values, rather than making pain reduction the goal.

In mindfulness-based stress reduction for chronic pain, the body scan teaches the client to:

1. notice sensations without judging them.
   The body scan moves attention slowly through the body, noticing each sensation, pain included, with curiosity and without judging or trying to change it.
2. tense and release each muscle group.
   Tensing and releasing muscle groups is progressive muscle relaxation, a different technique.
3. replace pain with pleasant mental imagery.
   Replacing pain with images is guided imagery; the body scan observes what is present rather than substituting something else.
4. shift attention away from the pain.
   Shifting attention away is distraction; mindfulness turns toward sensations instead.