Professional Documents
Culture Documents
MULTIPLE CHOICE
3. Uncontrollable conflict and discrepancy bring stress to the client resulting in ____.
a. active inhibition of neurons and damaging glucocorticoids and cortisol are released
b. gradual strengthening of an individual through development of protective neural structures
c. an ultimate challenge to the counselor
d. the need to refer the client to the emergency room for medication
ANS: A PTS: 1 REF: Page 236
TOP: Module: Defining Empathic Confrontation
5. Careful listening is one of the most powerful influencing skills. Which one of the following statements
about influencing is NOT true?
a. Paraphrasing is particularly useful when decisions need to be made.
b. Reflection of feeling is useful to feedback of mixed emotions.
c. Direct and firm confrontation helps clients identify their errors.
d. A good summary brings together many thoughts, feelings and behaviors.
ANS: C PTS: 1 REF: Page 236
TOP: Module: Defining Empathic Confrontation
8. As a result of effective and empathic confrontation, a counselor or interviewer can anticipate that the
client will ________.
a. resolve his or her issues
b. move to a more productive topic
c. come up with new ideas, thoughts, and feelings
d. become angry
ANS: C PTS: 1 REF: Page 236
TOP: Module: Defining Empathic Confrontation
9. Which one of the following is NOT a technique to supportively challenge or confront a client?
a. Observe and note discrepancies and conflict.
b. Feed back internal and external discrepancies to the client.
c. Match tonal quality with the client during the feedback of discrepancies.
d. Evaluate the client response and whether there is client change.
ANS: C PTS: 1 REF: Page 236
TOP: Module: Defining Empathic Confrontation
11. _______________ is essential if you are to challenge the client with a confrontation.
a. An empathic relationship
b. An assertive personality
c. A strong affirmation
d. All of the above
ANS: A PTS: 1 REF: Page 237
TOP: Module: Empathy and Nonjudgmental Confrontation
15. "On the one hand..., and on the other hand..." This is typically used in _________.
a. reframing
b. empathic confrontation
c. psychoeducation
d. interpretation
ANS: B PTS: 1 REF: Page 238
TOP: Module: The Skills of Empathic Confrontation: An Integrated Three-Step Process
20. Incongruities and discrepancies of the interviewee to be identified include all EXCEPT which of the
following?
a. Between two statements
b. Between statements and nonverbal behavior
c. Between the influencing skill used by the interviewer and the interviewee response
d. Between what one says and what one does
ANS: C PTS: 1 REF: Page 239-240
TOP: Module: Step 1: Listening
21. "You really want to meet him, but you're a little bit anxious." In which step of supportive confrontation
would an interviewer most likely make this statement?
a. Step 1: Identify conflict
b. Step 2: Point out issues of incongruity
c. Step 3: Evaluating change
d. This is not included in supportive confrontation.
ANS: A PTS: 1 REF: Page 239-240
TOP: Module: Step 1: Listening
22. Discrepancies between the client and the external world include:
a. conflict between the client and another person.
b. conflict between the client and a challenging situation.
c. conflict between the client and a nurse at a hospital.
d. all of the above.
ANS: D PTS: 1 REF: Page 239-240
TOP: Module: Step 1: Listening
24. "On the one hand..., and on the other hand..." In which step of empathic confrontation would an
interviewer most likely make this statement?
a. Step 1: Identify conflict
b. Step 2: Summarize
c. Step 3: Evaluate
d. This is not included in supportive confrontation.
ANS: B PTS: 1 REF: Page 241 TOP: Module: Step 2: Summarize
25. Regarding discrepancies between you and your client, which of the following is NOT true?
a. Never hide differences you may have with your client.
b. If you sense differences, support the client by listening.
c. Note your own or the client's discomfort with possible differences.
d. If you listen carefully, most discrepancies with your client will disappear.
ANS: A PTS: 1 REF: Page 240-241
TOP: Module: Step 2: Summarize
26. Which of the following statements about the Client Change Scale (CCS) is NOT true?
a. CCS measures the effectiveness of confronting clients about mixed messages.
b. CCS assesses the client’s position relative to how he/she copes with life changes.
c. CCS measures the intensity of counselor statements during direct confrontation.
d. The way a client deals with a variety of life change issues can all be considered using the
CCS.
ANS: C PTS: 1 REF: Page 243
TOP: Module: The Client Change Scale (CCS): The Creation of the New
27. Confrontation during a single session and over a series of interviews may be measured on a 5-point
scale called the Client Change Scale. Which of the following represents this scale?
a. Denial, Identification, Recognition, Generating Solutions, and Development
b. Denial, Partial Examination, Acceptance But No Change, Generation of New Solution,
and Transcendence
c. Identification, Examination, Acceptance, Forgiveness, and Evaluation
d. Identification, Partial Examination, Acceptance, Forgiveness, and Transcendence
ANS: B PTS: 1 REF: Page 243
TOP: Module: The Client Change Scale (CCS): The Creation of the New
28. The reality of the story is acknowledged during __________________ of the Client Change Scale
(CCS).
a. Level 1: Denial
b. Level 2: Partial examination
c. Level 3: Acceptance and recognition, but no change
d. Level 4: Generation of a new solution
ANS: C PTS: 1 REF: Page 243-246
TOP: Module: The Client Change Scale (CCS): The Creation of the New
30. Achieving a major more lasting transformation in client thinking and behavior may require:
a. several interviews.
b. time to internalize new solutions.
c. moving from denial or partial acceptance.
d. all of the above.
ANS: D PTS: 1 REF: Page 243-246
TOP: Module: The Client Change Scale (CCS): The Creation of the New
31. A client who is dying comments, "It won't happen—not to me." This is an example of:
a. denial.
b. partial acceptance of reality.
c. acceptance and recognition.
d. generation of a new solution.
ANS: A PTS: 1 REF: Page 243-246
TOP: Module: The Client Change Scale (CCS): The Creation of the New
32. After four interviews, Dominic comments, “Wow, it's really working. Things are great at home. Sara
and I are doing well. Working together works!” Dominic is in what level of the CCS scale?
a. Denial
b. Partial examination
c. Acceptance and recognition, but no change
d. Development of new, larger, and more inclusive constructs, patterns, or behaviors—
transcendence
ANS: D PTS: 1 REF: Page 243-246
TOP: Module: The Client Change Scale (CCS): The Creation of the New
Instructions: Imagine that you are talking with a client about emotional child abuse. You have just
confronted the client with the following statement: "On one hand, you say you love your child, but on
the other hand you continue to put her out in the hall of your apartment where you force her to stand in
the dark. How do you put that together?"
33. Client response: "I understand what you are saying, it just doesn't make sense what I'm doing. I seem
to be saying one thing, but doing another."
34. Client response: "I don't understand what you are saying. There's no need to put it together. There's no
problem. That's the way I do it."
35. Client response: "I think I see what you're saying. There is a big incongruity there. I want to stop, but I
was abused and hit by my parents. I think I'm doing better than they did ⎯ at least I don't strike Amie.
But perhaps I can do something different next week. I'll try your new idea about disciplining her."
36. Client response: "Yes, I do love her. I care for her very much. She is extremely important to me. We
do everything together. We really do so many things that work out OK."
37. Client response: "I heard what you are saying. I want to change, but right at the moment I just can't do
what I want. I tried last week, it didn't work. The divorce is getting to me. I'll do the best I can to
change, but it is so hard."
38. "I've been avoiding my anger, and it is getting in my way. I’m going to start dealing with it." An
interviewer may hear this statement in which level of the Client Change Scale (CCS)?
a. Level 1: Denial
b. Level 4: Generation of a new solution
c. Level 5: Development of new constructs, patterns, or behaviors
d. Level 3: Acceptance and recognition, but no change
ANS: B PTS: 1 REF: Page 243-246
TOP: Module: The Client Change Scale (CCS): The Creation of the New
39. An interviewer may hear, "Yes, I hurt and perhaps I should be angry," in which level of the Client
Change Scale (CCS)?
a. Level 1: Denial
b. Level 2: Partial examination
c. Level 3: Acceptance and recognition, but no change
d. Level 5: Development of new constructs, patterns, or behaviors
ANS: B PTS: 1 REF: Page 243-246
TOP: Module: The Client Change Scale (CCS): The Creation of the New
40. An interviewer may hear, "You helped me see my mixed feelings; I need to express my feelings
more," in which level of the Client Change Scale (CCS)?
a. Level 1: Denial
b. Level 2: Partial examination
c. Level 3: Acceptance and recognition, but no change
d. Level 5: Development of new constructs, patterns, or behaviors
ANS: D PTS: 1 REF: Page 243-246
TOP: Module: The Client Change Scale (CCS): The Creation of the New
42. Which of the following is NOT part of the Racial/Identity Development Model?
a. Disillusionment Stage
b. Resistance and Immersion Stage
c. Introspection Stage
d. Integrative Awareness Stage
ANS: A PTS: 1 REF: Page 252
TOP: Module: Cultural Identity Development and the Confrontation Process
44. Which of the following contextual factors may lead to clients’ low self-worth and self-esteem?
a. Self-talk and internal dialogue
b. Cognitive distortions and negative schemas
c. Oppression and racism
d. All of the above
ANS: C PTS: 1 REF: Page 253
TOP: Module: Cultural Identity Development and the Nelida/Allen Counseling Sessions
45. If your client starts with you at denial or partial acceptance (Level 1 or 2) and then moves with your
help to acceptance and generating new solutions (Level 3 or 4), you have clear evidence of:
a. the effectiveness of your therapy process.
b. the capacity of your client to achieve progress without your help.
c. the strong need for leadership and direction your client has.
d. the powerful impact of the environment on our clients.
ANS: A PTS: 1 REF: Page 255
TOP: Module: The CCS as a System for Assessing Change Over Several Sessions
46. Which of the following statements regarding empathic confrontation and mediation is NOT true?
a. There is a need for actual contact and communication between combatants.
b. Power needs to be equal between the two individuals or groups.
c. There is need to search for common goals and areas of agreement.
d. A win-win resolution is most achievable when two individuals or groups meet to address
issues.
ANS: D PTS: 1 REF: Page 255
TOP: Module: Conflict Resolution and Mediation: A Psychoeducational Strategy for Creating the
New
Instructions: Imagine you are a counselor or therapist working with an array of client problems. You
make a statement or have approached a case in a certain way. Then the client responds.
For example, imagine a client who is being abused by her husband. You, as interviewer, may say:
"Jane, this is the third interview in a row that you've come in beaten and bruised. Each time you say
you need to try harder to meet your husband's expectations. When are you going to realize that it is he
who is at fault, not you?"
1. "But, I can't do anything about it. I have no place to go. I've simply got to try harder.
Won't you please help me do better?"
2. "Yes, you're right, I am beginning to think he is involved in this, too. But I know how hard
he works and if we just hang in there, maybe it will work out."
3. "I guess you're right. I am trying to meet what he wants. I can't stand being beaten. I know
you think he's at fault and it isn't my responsibility to take care of him. I think I understand
what you are saying."
4. "I'm beginning to get your drift. I used to think I could solve things if I tried harder, but
I've been doing that now for months. Clearly, hitting me isn't right ⎯ it has to stop."
5. "Aha, I'm finally seeing what you mean. The more I try, the more he demands. I think the
situation isn't safe for me anymore. How can I plan to get out, just as soon as possible?"
The above five responses correspond to specific ways a client might respond in the interview. Below
are descriptions of each of the five responses. Note how the first response represents a form of denial,
the second a partial response, etc.
Level 1. Denial, The negative alpha solution. The client seems unable to accommodate new data from
the counselor or therapist. The client will fail to deal with the conflict or contradiction, make an abrupt
topic shift, or show a clearly incorrect "off-the-wall" response.
Level 2. Partial examination, The more mature alpha solution. The client deals with only a portion of
the issue or counselor's statement. The client may over-generalize, delete, or distort what has been
said, but not as seriously as in Level 1. You may find irrational ideas and some blindness to problems.
Level 3. Acceptance and recognition, Beta solution. The client recognizes the situation as it is and the
client's comment, feeling, or thought seems close to that presented by the therapist, but nothing new is
added by the client. This level characterizes homeostasis or no change. Score as Beta if the client tends
to describe a situation, event, or self-picture fairly clearly, but tends to leave it there.
Level 5. Transcendence, Full gamma solution. The client has arrived at a new synthesis, a new way of
thinking, behaving, or feeling. These are relatively rare moments in counseling and therapy and may
represent the development of useful or important insights, the ability to engage in a truly new way of
behaving, the generation of a new ability to engage emotionally.
You will now be given a variety of counselor-client situations. The possible client responses are in
random order. Please classify each client response at one of the five levels.
1. Career choice
Counselor: (To student who was referred by his engineering professor for failing grades) "John, we've
gone through the tests and reviewed your work history. Given all the information we've come up with,
how do you put it together?"
Client:
a. "Well, I see the results. They seem to be saying that I don't look like an
engineer and that I appear more like a journalist or English major. And, it's true
that I haven't done too well in math and that English courses have given me my
best grades."
b. "The tests don't seem to make much sense. I'm going to work harder. I can't
see why they referred me here anyway."
c. "It makes sense. I did enjoy the English courses. I guess it's time to give myself
a chance to do what I want. My dad wanted me to be an engineer like him. I've
always tried to please him too much."
d. "I don't know. Engineers make the best salaries. It's really important that I do
what dad wants."
e. "That settles it. I've given dad's idea a good try, but I haven't done well and I
really like English better. I am going to do what I want and makes sense for me.
I'm going to change my major."
ANS:
a. 3
b. 1
c. 4
d. 2
e. 5
2. Depressed client
Counselor: (To hospitalized patient) "Could you tell me what brought you to the hospital?"
b. (Tears⎯no response)
d. "Well, when I came here I was pretty depressed and mom was worried. But now
I'm doing a better. Last night I slept through the whole night for the first time."
ANS:
a. 3
b. 1
c. 2
d. 4
e. 5
The following client statements could be expected following the discovery that the client has terminal
cancer.
a. "It's so hard for me all the time. But it's hard for the family, too. Sometimes I
just cry. But lately, I find that if I focus on the positives available to me still, I gain
some peace."
b. "There really isn't any problem. I'm sure it's an error on the X-ray. It can't be
correct."
d. "I've been spending my time working with a cancer support group. I want to
help others face this ⎯ somehow fighting and working with others to the end
makes it seem easier."
e. "I accept it. I've had a good life, with my share of problems for sure. Sure I
don't like it, but there's nothing I can do."
ANS:
a. 4
b. 1
4. Gestalt therapist
Therapist: "You say you're angry at your lover, but I see you smiling. Phony!"
a. "What do you mean ⎯ I'm really mad. You can't say that."
c. "OK, OK. Let me try again." (angrily) "Jean ⎯ you really tick me off. You
simply can't do that."
e. "Dammit, I did it again! I'm beginning to think I'm afraid to allow myself to
really feel."
ANS:
a. 1
b. 3
c. 5
d. 2
e. 4
5. Family therapy
Therapist: "The problem with this family is not just Sue's eating problem; what we need to work on as
well is the way this family interacts."
a. Mother: "Somehow that makes sense. I never thought of it that way before."
b. Father: "Yes, I now see that our perfectionism and constant demand for success
left her with a feeling of being empty."
c. Sue: (5'6", 87 pounds) "I don't see why all the fuss. I'm overweight a little,
that's all."
d. Mother: "Yes, doctor, that way we can work together better and you can help
show us how to get Sue to eat."
e. Mother: "I see how we've avoided our own conflicts and used Sue to help us
hide them. We're going to be more direct in the future."
a. 3
b. 4
c. 1
d. 2
e. 5
6. Carl Rogers
(To Mrs. Oak) "It's an experience that's awfully hard to put down accurately into words, and yet I get a
sense of difference in this relationship, from the feeling that 'This is mine,' 'I am doing it,' and so on, to
a somewhat different feeling that ⎯ 'I could let you in'."
a. "Yes, it's as though that's how it should be. There's a feeling that this is good. I
feel that it's right for me. I feel more open. I feel more me."
ANS:
a. 5
b. 2
c. 1
d. 3
e. 4
7. Child counseling
a. "I know she's the best student and I'm jealous. It makes me mad that I can't do
as well. I'll try not to do it again ⎯ next time I'll count to ten like you taught me to
do when I get angry."
b. "I didn't do good in math today and she laughed. I felt bad."
ANS:
a. 5
b. 4
c. 3
d. 2
e. 1
TRUE/FALSE
1. The counselor's or interviewer's task is to move clients beyond their issues and problems to realize
their potential as human beings.
2. Confrontation is relevant to all clients, but it must be worded to meet individual and cultural needs if
real creativity is to occur.
4. If you observe closely in the here and now of the session, you can rate how effective your
interventions have been.
5. You can assess the direct impact of confrontation, as well as any other microskill, in the here and now
with the Client Change Scale (CCS).
6. Clients complete each developmental task in fairly quick succession, and their progress can be quickly
assessed on the Client Change Scale (CCS).
7. Nelida and Allen’s two sessions highlight the importance of helping clients address conflicts related to
racial/cultural identity.
8. If you practice assessing client responses with the CCS model, eventually you will be able to make
decisions automatically “on the spot” as you see how the client is responding to you.
11. According to Ivey, Ivey, and Zalaquett, empathic confrontation is a not a distinct skill; it is a set of
skills that may be used in different ways. The most common confrontation uses the paraphrase,
reflection of feeling, and summarization of discrepancies observed in the client, or between the client
and her or his situation. However, questions and influencing skills and strategies can also lead to client
change.
12. According to the authors, empathic confrontation is a distinct skill that relies heavily in influencing
skills and strategies to client change.
ESSAY
1. A client comes to you saying the following: "I have no problems in stopping smoking, I've stopped ten
times in the last year."
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Answer not provided.
PTS: 1
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Answer not provided.
PTS: 1
3. Describe the integrated steps of empathic confrontation and provide examples of each.
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Answer not provided.
PTS: 1
4. Present the Client Change Scale and explain how it is used in counseling and therapy. Illustrate each of
the levels and uses.
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Answer not provided.
PTS: 1
5. Explain and illustrate with clear examples the different stages of the Racial/Cultural Identity
Developmental (R/CID) model.
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Answer not provided.
PTS: 1
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Answer not provided.
PTS: 1