Que s tions : 82–93 97

i ort nt the tic roof th t she u st 91. The tient is 59-ye r-o fe e w ith schizo-
finish w riting. She’s convince th t the uni- hreni , s w e s oor y contro e i betes
versity w i i e i te y gr nt her tenure s e itu s, obesity, hy er i i e i , n hy er-
soon s they see the roof, thou gh she h s tension. She h s been tre te for over 35 ye rs
troub e st ying on to ic w hen you sk qu es- w ith v riou s first-gener tion nti sychotics,
tions bout it. She h s not seen sychi trist n thou gh she is on n equ te ose, she
before, n u rine toxico ogy screen, w hich sti h s resi u sychotic sy to s n h s
she consents to “to rove I’ not cr zy,” is now begu n to eve o invo u nt ry b inking
neg tive. Which of the fo ow ing is the ost n tongu e-ro ing ove ents. She is gree-
ro ri te gent for initi n inten nce b e to sw itching to n ty ic / secon -gen-
tre t ent of this tient? er tion nti sychotic. Which of the fo ow ing
e ic tions w ou be the ost ro ri te
(A) H o eri o
for this tient?
(B) L otrigine
(C) Lithiu (A) Ari i r zo e
(D) Lor ze (B) C oz ine
(E) O nz ine (C) O nz ine
(D) Qu eti ine
89. A 34-ye r-o e ectric engineer co ins to (E) Ris eri one
his octor th t he h s been fee ing e resse
for sever onths fter the bre ku of his 92. You ev u te 34-ye r-o ivorce , e, w ith
rri ge. Since th t ti e, he h s h signifi- history of coho use isor er w ho resents
c nt inso ni , ifficu ty concentr ting, h s w ith the chief co int of “I c n’t sto rink-
ost 25 b in the st 3 onths bec u se his ing, oc.” He h s h sever reh bi it tion
etite isn’t the s e, fee s f tigu e , h s sig- issions but is un b e to int in sobriety.
nific nt fee ings of gu i t reg r ing the se r - He is current y rinking one-fifth of vo k
tion, fee s ho e ess n he ess, n h s fe t ost i y. Whi e he is very iscour ge n
su ici w ithou t s ecific n. A i gnosis of gui ty bout his coho use, he is ho efu bout
jor e ressive isor er is e n he is getting better, n he enies erv sive e res-
begu n on n nti e ress nt. Which of the fo - sive sy to s or suici i e tion. H e h s
ow ing sy to s w ou be ex ecte to t ke rior history of signific nt coho w ith r w ,
the ost ti e to i rove? inc u ing one seizure n e iriu tre ens,
both requiring n ICU ission. Which of the
(A) Decre se etite
fo ow ing e ic tions w ou be ost ro-
(B) Decre se concentr tion ri te to rescribe for this tient?
(C) Decre se energy
(A) Disu fir
(D) Inso ni
(B) Meth one
(E) Su ici ity
(C) N trexone
90. A 58-ye r-o n w ith history of cirrho- (D) Sertr ine
sis, he titis C, n coho is w ishes to qu it (E) V roic ci
rinking bu t w nts to etox first. Which of
the fo ow ing e ic tions w ou be the ost 93. A 35-ye r-o sing e n resents to you r
ro ri te to rescribe in this tient? office co ining of inso ni . H e re orts
th t he is b e to f s ee t night, bu t st ys
(A) A r zo
s ee for on y 2 or 3 hou rs, then w kes u fre-
(B) Ch or i ze oxi e quent y throu ghout the night. H e is exh uste
(C) C on ze n w ou ike so ething to he hi s ee .
(D) Di ze Other th n fee ing fru str te n f tigue
(E) Lor ze u ring the y, he enies other e ressive
98 3: S oma tic Tre a tme nt a nd P syc hop ha rma c ology

sy to s or ny st sychi tric history. e ic tions w ou be the ost ro ri te to

Which of the fo ow ing e ic tions w ou be rescribe?
the ost ro ri te for this tient?
(A) Bu s irone
(A) A itri ty ine (B) F u oxetine
(B) R e teon (C) F u vox ine
(C) Tr zo one (D) Lor ze
(D) Z e on (E) Pro r no o
(E) Zo i e
97. A 30-ye r-o e resents w ith 4 w eeks
94. A 40-ye r-o rrie , regn nt w o n w ith of ow energy, oor s ee , oor etite,
history of hy ertension, yoc r i inf rc- ecre se interest in e su r b e ctivities,
tion, egener tive isc ise se, n jor n ow oo . H e re orts being hos it -
e ressive isor er w ith sychotic fe tu res ize s you ng u t for 2-w eek erio of
is being consi ere for e ectroconvu sive gr n iosity, hy ersexu ity, ecre se nee
ther y (ECT) fter f i ing u ti e nti e- for s ee , n eng ging in risky beh viors. H e
ress nt n nti sychotic tri s. Which of w s st rte on ithiu bu t i not to er te the
the fo ow ing con itions w ou be re tive e ic tion u e to eve o ent of i betes
contr in ic tion to ECT? insi i u s n h s not t ken e ic tion since.
H e w orks s n ccou nt nt, his BMI is 35, n
(A) Degener tive isc ise se
his st A1c w s 5.2. Which of the fo ow ing
(B) H y ertension e ic tions w ou be the ost ro ri te to
(C) Pregn ncy rescribe for this tient?
(D) Psychotic e ression
(A) Lithiu
(E) Recent yoc r i inf rction
(B) Lu r si one
95. You re c e to consu t on 70-ye r-o (C) Qu eti ine
w o n, hos it ize in the ICU fter yo- (D) Sertr ine
c r i inf rction. The tient is ye ing t (E) V roic ci
st ff, u ing ou t her IV n trying to get out
of be . She refuses to t ke ny e ic tion by 98. A 29-ye r-o w o n w ith history of sei-
outh. H er ECG show s QTc of 480. Which zu res is i gnose w ith bi o r isor er,
of the fo ow ing e ic tions w ou be best to ost recent e iso e e resse , n st rte
he her git tion? on otrigine. Abou t w hich of the fo ow ing
si e effects w ou be the ost i ort nt to
(A) Ari i r zo e IM
e u c te the tient?
(B) Di ze IV
(C) H o eri o IV (A) Acu te ystoni
(D) Lor ze IV (B) Ak thisi
(E) Ris eri one Const IM (C) A stic ne i
(D) R sh
96. A 30-ye r-o w o n w ith no reviou s sy- (E) Ren f i u re
chi tric history resents to you r office sking
for he in n ging erfor nce nxiety. 99. A 19-ye r-o n w ith bi o r isor er is
She oves to ct n sing in her co unity brought in to the e ergency roo by the
the tre, but she beco es terrifie w hen get- o ice. H e is gr n iose n e usion , s w e
ting on st ge in front of crow s. As resu t, s git te n co b tive. H e is given n
her voice sh kes n she h s been un b e intr uscu r injection of h o eri o . After
to get “goo rts.” Which of the fo ow ing 30 inutes, the tient is fou n rching for-
w r . On hysic ex in tion, stiffness of the
 Que s tions : 94–104 99

neck n b ck usc es re note . Which of the 102. A 58-ye r-o n w ith tri fibri tion,
fo ow ing ter s best escribes this si e effect? hy ercho estero e i , n hy ertension is
sent to you by his ri ry c re hysici n
(A) L ryngos s
for he in n ging his nxiety. H e re orts
(B) Ocu ogyric crisis th t for ny ye rs he h s w orrie “ bout
(C) O isthotonos everything,” n th t he occ sion y h s to
(D) P eu rothotonos st y ho e fro w ork bec use he beco es so
(E) Tortico is fe rfu . H e often h s ifficu ty f ing s ee
n not u nco on y gets tension he ches
100. The tient is 59-ye r-o w o n w ith st w hen rticu r y stresse . H is e ic tions
e ic history of hy ercho estero e i , i - inc u e w rf rin, torv st tin, n hy ro-
betes, n i betic neu ro thy, w ho resents ch orothi zi e. H e oes not rink coho or
to her ri ry c re octor w ith the chief co - c ffeine. Which of the fo ow ing e ic tions
int of “he ches.” U on further interview, w ou be the ost ro ri te to tre t this
she st tes her sy to s beg n fter the e th tient’s sy to s?
of her hu sb n 5 onths go. Since th t ti e, (A) Bu ro ion
she h s fe t “e ty,” w ith oor s ee , f tigu e,
(B) Bu s irone
ecre se concentr tion, n w ishes th t she
“w ou ie so I c n join hi .” H er review of (C) Cit o r
syste s is re rk b e for ongoing “sh r ins (D) C on ze
n nee es” in her extre ities. H er hysic (E) Ven f xine
ex in tion is u nre rk b e, n her b oo
su g rs h ve been re tive y w e contro e . 103. A 40-ye r-o n is st rte on f u oxetine for
Which of the fo ow ing w ou be the ost jor e ressive isor er. H e notes i rove-
ro ri te tre t ent for her sy to s? ent in his oo , bu t h s ifficu ty s ee ing.
Tr zo one is su bsequ ent y e to his regi-
(A) Bu ro ion
en. Three ys ter, he c s co ining of
(B) Du oxetine infu erection th t h s not su bsi e fter
(C) F u oxetine sever hou rs. Which of the fo ow ing best
(D) Mirt z ine escribes this tient’s con ition?
(E) Re ssu r nce (A) Erecti e ysfu nction
(B) Ny ho ni
101. A 44-ye r-o rrie e tient w ith his-
tory of recurrent jor e ressive isor er (C) P r r xis
resents to sychi trist fter sto ing his ser- (D) Pri is
tr ine 1 onth go. A though it h s been effec- (E) S tyri sis
tive in the tre t ent of his e ression, he h s
h incre sing ifficu ty int ining n erec- 104. A 35-ye r-o rrie fe e is being fo -
tion, n this h s c use friction n conf icts ow e by sychi trist for her first e iso e
w ith his w ife. H e is concerne , how ever, th t of jor e ression. She is rescribe cit o-
he w i h ve re se of his e ressive sy - r 40 g i y n h s been in re ission
to s if not e ic te . Which of the fo ow ing for 3 onths. She now co ins of the new
w ou be the ost ro ri te h r co ogic onset of ecre se ibi o w hich is c u sing her
tre t ent for this in ivi u ? o er te ou nt of istress. Which of the
fo ow ing w ou be the ost ro ri te to
(A) Begin irt z ine.
to her cu rrent regi en?
(B) Begin roxetine.
(C) Begin ven f xine. (A) Bu ro ion
(D) N o e ic tion. (B) Desi r ine
(E) Rest rt sertr ine. (C) Lithiu
100 3: S oma tic Tre a tme nt a nd P syc hop ha rma c ology

(D) Tr ny cy ro ine 107. A 16-ye r-o boy is brou ght to you by his
(E) Ven f xine other. She st tes th t, es ite h ving high
IQ, he oesn’t co ete his ho ew ork, h s
105. A 41-ye r-o w o n resents to you r office been f i ing in schoo , n h s sto e going
sking for he in n ging her binge e t- out w ith frien s. H e its to s oking tw o to
ing. She e ts rge ou nts of ju nk foo three three joints of riju n i y.
or fou r ti es w eek, hi es foo , n su bse-
qu ent y fee s gu i ty bou t her ctions. H er 108. A 21-ye r-o n is brou ght into the e er-
BMI is 31. After erfor ing thorou gh his- gency e rt ent by the o ice fter getting
tory n hysic ex in tion, you eci e to rreste for ste ing g so ine. The tient fee s
rescribe to ir te. Which of the fo ow ing isconnecte fro re ity n frightene . On
si e effects o you te her is ost ike y? hysic ex in tion, he is note to h ve
(A) I rove ttention r sh rou n his ou th.
(B) P ncre titis
(C) Po yu ri 109. A 54-ye r-o n w ith o i te u se isor er
re se on heroin fter sever onths of
(D) Ren stones
sobriety. Whi e he beg n u sing $10 to $20 er
(E) Weight g in
y t first, he qu ick y incre se his u se to $50
to $60 er y bec u se “I on’t get high now
D IRECTION S (Questions 106 through 109): The
u n ess I u se ore.”
follow ing group of questions are preceded by a
list of lettered options. For each question, select
the one lettered option that is most closely asso- D IRECTION S (Question 110): Select the lettered
ciated w ith it. Each lettered option may be used answ er that is the one best response in this case.
once, multiple times, or not at all.
110. A 27-ye r-o n w ith schizo hreni notices
Questions 106 through 109 the eve o ent of bre sts, ecre se ibi o,
n not ej cu ting w hen he h s n org s .
For the fo ow ing vignettes, choose the correct ter Which of the fo ow ing e ic tions is ost
fro the ist be ow . ike y res onsib e for these si e effects?
(A) A otiv tion syn ro e (A) Ari i r zo e
(B) C nn bis (B) C oz ine
(C) For ic tion (C) Qu eti ine
(D) H u cinogen ersisting erce tion (D) Ris eri one
isor er (E) Zi r si one
(E) Inh nts
(F) Intoxic tion D IRECTION S (Questions 111 through 121): The
(G) Psycho ogic e en ence follow ing group of questions are preceded by a
(H ) Su bst nce u se isor er list of lettered options. For each question, select
the one lettered option that is most closely asso-
(I) To er nce
ciated w ith it. Each lettered option may be used
(J) With r w once, multiple times, or not at all.

106. A 45-ye r-o n w ith chronic coc ine u se Questions 111 through 121
isor er resents to the e ergency e rt-
ent w ith co ints of bugs cr w ing on his For the fo ow ing vignettes, choose the correct si e
skin. effect fro the ist be ow .
(A) Agr nu ocytosis
(B) Ak thisi
 Que s tions : 105–122 101

(C) B e h ros s gener ize rigi ity, i horesis, n tere

(D) Consti tion ent st tu s.
(E) G ctorrhe
(F) Gyneco sti 117. A 36-ye r-o n w ith schizo ffective is-
(G) N eu ro e tic ign nt syn ro e or er, e resse ty e h s been receiving f u -
hen zine ec no te 50 g intr u scu r y
(H ) Obstru ctive j u n ice
every 2 w eeks. Whi e his sy to s re w e
(I) O isthotonos
contro e , he h s recent y notice w hite
(J) Orthost tic hy otension isch rge fro his ni es, bi ter y.
(K) Pig ente retino thy
(L) Pseu o rkinsonis 118. A 26-ye r-o n being tre te w ith high-
(M) R bbit syn ro e ose thiori zine is fou n on o hth o ogic
(N ) Retrogr e ej cu tion ex in tion to h ve e ery ig ent tion
(O) T r ive yskinesi of the retin . Des ite iscontinu tion of the
(P) Tortico is e ic tion, the ig ent tion continu es n
the tient eventu y suffers tot b in ness.
111. A 35-ye r-o n w ith chronic schizo hreni
t king thiori zine notices th t, if he urin tes 119. A 22-ye r-o n co ins of severe rest-
fter sturb ting, his u rine e rs c ou y. essness n git tion fter st rting on ri i -
r zo e. H e co ins th t he c nnot sit sti
112. A 46-ye r-o C uc si n w o n w ith schizo f- n ces const nt y.
fective isor er, bi o r ty e h s been n-
ge for ny ye rs on ris eri one 3 g tw ice 120. A 26-ye r-o tient w ith schizo hreni is
i y or y. She enies ny co ints but on st rte on ch or ro zine. After 1 w eek, he
ent st tus ex in tion is note to h ve co ins of f u - ike sy to s. A CBC is
re etitive, r i ove ents of her ou th (bu t obt ine n is nor . After nother w eek,
not tongue) w ith s cking of her i s. the tient eve o s ye ow ish co or to his
skin n sc er .
113. A 22-ye r-o Afric n-A eric n n on c o-
z ine for 3 onths re orts sore thro t n 121. A 45-ye r-o tient w ith schizo hreni is
fever. A CBC is obt ine w ith WBC cou nt of st rte on high ose of ch or ro zine. The
3
1,000/ w ith 1% gr nu ocytes. next y, he co ins of being ight-he e
every ti e he st n s. On ex in tion, he is
114. A 43-ye r-o n w ith schizo hreni is note to h ve signific nt ecre se in b oo
on h o eri o . H e is note to h ve f exe ressu re n n incre se in he rt r te.
osture, festin ting g it, resting tre or, n
br ykinesi . D IRECTION S (Questions 122 and 123): For each of
the multiple-choice questions in this section, select
115. The s e 43-ye r-o n w s continu e the lettered answ er that is the one best response in
on h o eri o es ite his si e effects n each case.
fter sever ye rs eve o e choreo thetoi
ove ents of the trunk n i bs, ong w ith 122. You re c e in the i e of the night by the
i s cking n tongu e ove ents. su rgic service to see 52-ye r-o n w ho
w s itte to the hos it for n e ergency
en ecto y. Review of the ch rt ocu ents
116. A 21-ye r-o n w ith sychosis w s nu erou s st hos it iz tions for coho
st rte on h o eri o t high oses. Eight intoxic tion n w ith r w . The su rgic
ys into his tre t ent, he eve o e fever, te is concerne bout his w ith r w ing
102 3: S oma tic Tre a tme nt a nd P syc hop ha rma c ology

w hi e in recovery. H ow ong fter this tient’s tri s of ithiu , v roic ci , n o nz -

st rink w ou you ost ike y ex ect to see ine, he is st rte on oxc rb ze ine. Three ys
serious w ith r w sy to s eve o ? ter, he co ins of n u se n w e kness;
he e rs confu se bou t w hy he is in the
(A) 6 hou rs
hos it . Which of the fo ow ing bor tory
(B) 12 hou rs stu ies w ou be the ost i gnostic in this
(C) 1 y c se?
(D) 3 ys
(A) BUN n cre tinine
(E) 7 ys
(B) CBC
123. A 33-ye r-o n w ith history of bi o r I (C) E ectro ytes
isor er is itte to the in tient u nit w ith (D) Liver fu nction tests
cu te ni . Bec u se he h s f i e reviou s (E) Oxc rb ze ine eve
 CHAPTER 4

Ps yc ho lo g ic al Tre atme nt and

Manag e me nt
Que s tions

DIRECTIONS (Questions 1 through 42): For each of (C) Ego strengths

the multiple-choice questions in this section, select (D) Projections
the lettered answ er that is the one best response in (E) Unconsciou s thou ghts
each case.
3. A 43-year-old m an is chastised at w ork. When
Questions 1 and 2 he com es hom e, his friend asks him how his
d ay w ent. H e respond s angrily saying that a
A 38-year-old m ale thinks that he is a “failu re and “real friend w ou ld n’t be so nosy.” Which of
w ill never find a p artner” w henever he feels rejected . the follow ing d efense m echanism s m ost likely
H e often find s him self getting d epressed and isolat- characterizes this reaction?
ing him self w hen he thinks like this. H is therap ist
thinks that it w ould be a good id ea for him to m ake (A) Denial
a log of the situ ations, his im m ed iate thou ghts, his (B) Disp lacem ent
im m ed iate feelings, alternate resp onses to those (C) H u m or
thoughts and feelings, and re-rate his feelings after (D) Intellectu alization
com pleting the exercise so they can be exam ined (E) Isolation of affect
d uring their sessions.
4. A 20-year-old w om an d iagnosed w ith bord er-
1. Which of the follow ing types of therapeu tic line p ersonality d isord er thinks of her thera-
ap proaches is the therapist m ost likely u sing? p ist as “the best person I’ve ever know n.” The
(A) Cognitive–behavioral next w eek, the therapist announces that he
(B) Exp ressive w ill be going on vacation. The patient becomes
enraged and states that he is “the cru elest
(C) H yp notherap y
d octor in the w orld !” Which of the follow ing
(D) Psychoanalysis d efense mechanism s best characterizes this
(E) Psychod ynam ic reaction?

2. Which of the follow ing term s refers to the (A) Devalu ation
im m ed iate thou ghts (e.g., “I am a failu re”) (B) Id ealization
that the p atient exp eriences and record s in this (C) Intellectu alization
type of therapy? (D) Repression
(A) Au tom atic thou ghts (E) Sp litting
(B) Core beliefs

123
124 4: P syc holog ica l Tre a tme nt a nd Ma nag e me nt

5. A 16-year-old boy has just lost his mother and m ind .” Which of the follow ing analytic tech-
father in a car accident. In your office, he talks niques d oes this best rep resent?
philosophically about death and its implica-
(A) Free association
tions. When asked how he feels about his par-
ents’ death, he responds by saying that “it is the (B) H yp nosis
nature of things to pass away.” Which of the fol- (C) Rep ression
lowing defense mechanisms best d emonstrates (D) Thou ght record s
this patient’s inability to talk directly about his (E) Transference
emotional experience concerning personal loss?
(A) Denial 9. A psychotherapist has been m eeting regu larly
w ith a 10-year-old boy for 18 months. During
(B) Intellectu alization
one of the therapy sessions, she find s herself
(C) Projection feeling very angry at the patient after he reports
(D) Su ppression “beating up” his little brother. Which of the
(E) Und oing follow ing phenomena is the psychotherapist
most likely exhibiting?
Questions 6 and 7
(A) Countertransference
A 44-year-old w om an w ith schizop hrenia is stru g- (B) Extinction
gling w ith p aranoia, au d itory hallu cinations, and (C) Interp retation
d elu sions. She lives w ith her m other but has a poor (D) Resistance
relationship w ith her. She tells you that everyone
(E) Transference
w ants her to sp end a lot of m oney and bu y d ru gs.
10. In an acu te inp atient p sychiatric u nit, the
6. Which of the follow ing resp onses w ou ld be
resid ent p sychiatrist is in charge of lead ing a
the m ost usefu l?
grou p consisting of p atients new ly ad m itted
(A) “Well, d ecid ing for you rself is best.” to the w ard . Du ring group d iscu ssion she asks
(B) “If you bu y d ru gs, I’ll call the p olice.” tw o participants to act out a scenario, d escribe
(C) “Perhap s w e shou ld look at w hat you r their feelings abou t the situ ation, and then
m other w ou ld think abou t that.” exp lore the ind ivid u al conflicts w hich arose.
Which of the follow ing techniques of p sycho-
(D) “Why d o you think everyone w ants you
therapy d oes this m ost represent?
to d o that?”
(E) “N o, they d on’t.” (A) Feed back
(B) Free association
7. You d ecid e that su p p ortive therap y w ou ld be (C) Go-arou nd
helpfu l to this patient. Which of the follow ing (D) Psychod ram a
w ou ld be the m ost ap p rop riate goal of su p -
(E) Resistance
p ortive therap y for this p atient?
(A) Correcting fau lty id eas Questions 11 and 12
(B) Exp loring the feeling of m eaninglessness
A 28-year-old fem ale p atient w ho is ad d icted to opi-
in life
oid analgesics states that she has been up set w ith
(C) Investigating the freed om of ind ivid u als fam ily for not continu ing to su p p ort her financially
(D) Personality change and allow ing her to stay w ith them . She has been
(E) Strengthening of d efenses u nem ployed for m any years since leaving college.
They recently told her that she shou ld be m ore ind e-
8. A 32-year-old p sychiatry resid ent is in p sycho- p end ent; they w ant her to start w orking and find a
analysis 4 d ays p er w eek. H e is encouraged to p lace to live. In her next therap y session, she tells
lie on the cou ch and say “w hatever com es to her therapist that she u nd erstand s w hy they w ou ld
 Que s tions : 5–16 125

say that, bu t then goes on to d escribe a fight w ith her 14. A 34-year-old male is referred by his job because
boyfriend , stating she w ants to break u p w ith him of ongoing interpersonal conflicts. During
becau se he is not su p p ortive of her. H er therap ist the interview, he appears very focused on his
asks if it is p ossible she is u pset at her parents for health, his attractiveness to others, and his suc-
w anting her to be m ore ind ep end ent bu t exp ressing cess at work. When confronted with his diffi-
this anger tow ard her boyfriend instead . culties, he becomes defensive, blaming others,
and accusing them of being “jealous of me.” He
11. Which of the follow ing therapeu tic techniqu es describes himself as “better” than his friends
best d escribes the therap ist’s resp onse? and colleagues and admits to taking advantage
of others in order to “get what I deserve.” Which
(A) Cou ntertransference
of the following treatment modalities would be
(B) Em p athy the most appropriate for this patient?
(C) Interp retation
(A) Anger m anagem ent
(D) Parad oxical intervention
(B) Com bined ind ivid u al and grou p
(E) Working throu gh
therapy
12. The p atient’s fam ily m em bers and close (C) Psychoanalysis
friend s w ork w ith the therap ist and join the (D) Psychopharm acotherap y
p atient in a session. Du ring the m eeting, they (E) Social skills training
tell her about her m alad aptive behaviors and
how they have affected her and her fam ily 15. A 29-year-old w om an has been d epressed for
negatively. They then give her an u ltim atu m , 2 months prior to seeking med ical attention.
w hereby if she d oes not get treatm ent for her She believes that nobod y likes her even though
ad d iction they w ill not continu e to su pp ort she is alw ays cord ial, and that there is noth-
her. Which of the follow ing techniqu es best ing she can d o to change the w ay other people
d escribes this scenario? perceive her. Therefore, w hen she is around
peop le she feels tense and u ncomfortable and
(A) Behavioral therap y
has started avoid ing leaving the hou se. Which
(B) Fam ily therap y of the follow ing cognitive–behavioral therapy
(C) Grou p therap y (CBT) interventions w ould most d irectly target
(D) Intervention the physical feelings she has around people?
(E) Relap se p revention (A) Cognitive restru cturing
(B) Exp osu res
13. A 24-year-old female patient with a history of
generalized anxiety disorder presents for therapy. (C) Keep ing a m ood d iary
In a previous session she reluctantly discussed (D) Keep ing a thou ght record
how much she did not like her new step-mother (E) Progressive m u scle relaxation
and didn’t approve of her father marrying her.
This session she reports that her step-mother is 16. After several weeks, a 40-year-old female patient
in the hospital and she has been spending most who is in psychodynamic psychotherapy begins
of the past few days at the hospital caring for her, to show up late and miss appointments; each
buying many get-well gifts and inserting herself time this happens she has a reason for doing
in her step-mother ’s care. Which of the following so. However, the therapist begins to feel that
concepts best describes this behavior? her behavior is interfering with her treatment.
The therapist is not sure if the patient under-
(A) Abreaction
stands that her behavior is inappropriate and
(B) Dep end ency potentially damaging to her therapy. Which of
(C) Projection the following topics would be the most impor-
(D) Reaction form ation tant to review with the patient before making
(E) Sp litting an interpretation of her behavior?
126 4: P syc holog ica l Tre a tme nt a nd Ma nag e me nt

(A) Bou nd aries and ru les d efining the w ay (D) Interp retation
in w hich therap y is cond u cted (E) Refram ing
(B) Focu s on the therapeu tic goals
(C) Method u sed to change the p atient’s Questions 19 and 20
m alad aptive thou ghts
An 18-year-old , single m an p resents to you r office
(D) Patient’s need for attention com plaining that he cannot pass a m ovie theater
(E) Reasons the p atient is late to the w ithou t stop p ing, going insid e, and bu ying cand y.
ap pointm ents This behavior is trou blesom e to him and interferes
w ith his d aily activities, resu lting in his being con-
17. A 45-year-old m an p resents to you r ou tp atient stantly late to other app ointm ents. You d ecid e to
clinic hand icap ped by a fear of parking lots help the p atient w ith behavior therap y.
and field s. The fear started 4 m onths p rior to
this visit. At the beginning of cognitive ther- 19. Which of the follow ing w ould be the m ost
ap y, he tells you that his behavior is constantly ap p rop riate focu s of the therapy?
being scru tinized and criticized by other
p eop le. H e claim s that he cannot change his (A) Analyzing the p atient’s relationship s
behavior, becau se if he d oes, others w ill think (B) Decreasing the m alad ap tive behavior of
he is a fool. Which of the follow ing w ou ld be stopping by m ovie theaters
the m ost appropriate response? (C) Exam ining the p atient’s negative eating
habits
(A) “That’s silly. People w ill not think you
are a fool.” (D) Exp loring the p atient’s child hood
trau m as
(B) “Yes, I can see that.”
(E) Working on resolving the p atient’s
(C) “What m akes you think th at others
u nconsciou s conflicts
are con stantly scru tinizing you r
beh avior?”
20. Which of the follow ing behavioral interven-
(D) “H ow can you possibly think other tions w ould be the m ost help fu l in this case?
p eople care enou gh abou t you to
constantly scru tinize your behavior?” (A) Aversion therap y
(E) “Well, m aybe you are a fool. H ave you (B) Environm ental m od ification
ever thou ght of that?” (C) Exp osu re and resp onse training
(D) Mod eling
18. A 32-year-old fem ale in therap y d escribes (E) Relaxation training
how she feels that she should have a life p art-
ner; and since she is not currently d ating, she 21. A 39-year-old m an p resents to you r office
is u nlikely to ever get m arried and is therefore com plaining of chronic “stress,” anxiety, and
u nlovable. H er therapist points ou t to her that p oor sleep. H e also ad m its to interm ittent
she has had a few m eaningful long-term rela- head aches, w hich you d iagnose as tension
tionships in the past and that she has d ated as head aches. You recom m end behavioral ther-
recently as a cou p le of m onths ago. The thera- ap y for red u ction of his head aches. Which of
p ist also explains that m any p eople m ay not the follow ing behavioral techniqu es w ould be
d ate, bu t this d oes not m ean they are u nlov- m ost appropriate for this patient?
able or w ill never get m arried . Which of the
follow ing term s best d escribes the therap eu tic (A) Aversive stim u li
intervention d escribed above? (B) Biofeed back
(C) N egative reinforcem ent
(A) Clarification
(D) Stim u lu s control
(B) Confrontation
(E) System atic d esensitization
(C) Em p athy

Questions 22 and 23
A 32-year-old m ale com p lains of ongoing d epression
for the past m onth w hich he attribu tes to the break-
up w ith his fiancée. H e has been having insom nia,
d ecreased appetite, and low energy, althou gh he
d enies anhed onia or problem s concentrating. H e
also d enies any su icid al id eation. H e has ju st started
to d ate som eone else w ithin the last w eek. After d is-
cussion w ith the patient, it is d ecid ed to u tilize both
m ed ication and interp ersonal psychotherap y for his
d ep ression.
22. Which of the follow ing goals w ou ld be the
m ost likely focu s of his p sychotherapy?
(A) Character change
(B) Clarifying com m u nication p atterns
(C) Strengthening d efenses
(D) Interpreting transference
(E) Pointing ou t resistance
23. Which of the follow ing techniqu es w ou ld
be m ost likely u tilized d u ring this p atient’s
therapy?
(A) Dream interp retation
(B) Defense analysis
(C) Free association
(D) H ypnosis
(E) Role p laying
Questions 24 and 25
A 22-year-old college stud ent presents com plaining
of having “no goals” in his life, not d oing as w ell as he
could in school, and d esiring but having no serious
long-term romantic relationships. H e has not chosen
a m ajor and states that his ind ecision is paralyzing
him from “m oving on w ith the rest of m y life.” After
d iscussing various form s of psychotherapy w ith the
patient, you recomm end psychoanalysis fou r times
per w eek.
24. Which of the follow ing is the m ost im p ortant
reason for the frequ ency of p sychoanalysis?
(A) Allow the p atient to get enou gh su p p ort
d u ring the course of their treatm ent.
(B) Allow transference to bu ild betw een
p atient and therapist.
Que s tions : 17–26 127
(C) Com p lete hom ew ork frequ ently to
better learn abou t their issu es.
(D) Prevent conflicts from arising betw een
the therapist and p atient.
(E) Requ ire m ore intensive treatm ent d u e to
severity of m ental illness.
25. Which of the follow ing w ou ld be the m ost
im p ortant tool in his p sychoanalysis?
(A) Altering cognitive d istortions
(B) Altering m alad ap tive behaviors
(C) Interp retation of transference
(D) Interp reting d ream s
(E) Solving interp ersonal p roblem s
26. A m ale th erap ist h as been w orkin g w ith a
fem ale p atient for over 3 years, enabling her
to im p rove her self-esteem and confid ence,
and to eventu ally d ivorce her em otion ally
abu sive h u sban d 1 year ago. The p atient con-
tinu ally thanks the therap ist and exp lains
that she is sexu ally attracted to the therap ist.
H e is initially taken aback and then som e-
w hat flattered by her sexu al interest. H ow -
ever, he also realizes that he feels a strong
attraction to her and feels the n eed to care
for her. Which of the follow ing w ou ld be the
m ost ap p rop riate n ext step for the th erap ist
to take?
(A) Act cold , show less em p athy, and set
m ore rigid bou nd aries d u ring sessions.
(B) Exp lore the p atient’s feeling in ord er to
increase her erotic transference.
(C) Ignore the p atient’s d isclosu re of her
sexu al attraction.
(D) Seek su p ervision w ith a m entor or
colleague.
(E) Term inate or fire the p atient from his
care.
Questions 27 and 28
You are seeing a 25-year-old man in cognitive–behav-
ioral therapy w ho suffers from generalized anxiety
d isorder, as w ell as epilepsy. H e often talks about
the many dreams he has w hile in his sessions, and
he is having a hard time w ith the restructuring of
128 4: P syc holog ica l Tre a tme nt a nd Ma nag e me nt

malad aptive thoughts. You d ecid e that hypnosis may relationships. He blames the problem on “his
be helpful as an adjunctive therapy for this patient, sabotaging things” when the women “start to
as he has been hypnotized before w ith good results get serious.” He is clearly ambivalent about his
and you have a skillful hypnotist in your clinic. The desire to “settle down” with someone. Accord-
patient is hopeful that hypnosis w ill be beneficial for ing to Erik Erikson, which of the following stages
him again. of development is the patient most likely in?
(A) Tru st versu s m istru st
27. Which of the follow ing characteristics is the
best p red ictor of resp onse to hyp nosis in this (B) Au tonom y versu s sham e
p atient? (C) Initiative versu s gu ilt
(D) Intim acy versu s isolation
(A) Patient has a lot of d ream s.
(E) Id entity versu s role confu sion
(B) Patient is resp onsive to su ggestion.
(C) Patient’s d iagnosis. 31. A 9-year-old boy w ith attention-d eficit/
(D) Patient w ith low seizu re threshold . hyperactivity disorder (ADHD), predominantly
(E) Trained hyp notist w ill be d oing his hyp eractive/ im p u lsive presentation, presents
treatm ent. to you r office accom panied by his m other. H e
is cu rrently on m ethylp henid ate (Ritalin) and
28. The p atient is started in hyp nosis, bu t there they both w ond er if there is som ething else
is a concern as to w hether he is in a trance that can be d one to help the patient. Despite
d u ring the sessions. Which of the follow ing som e benefit and tolerability, the child contin-
ind icators w ou ld be m ost likely increased in a u es to have d ifficulty w ith com pleting hom e-
trance state? w ork and follow ing instru ctions at school
and at hom e. H e has also recently gotten
(A) Am nesia
into a m inor p hysical fight w ith a p eer. Par-
(B) Pain p ercep tion ent m anagem ent training is recom m end ed for
(C) Pu lse the parents. Which of the follow ing aim s best
(D) Reflexes illu strates how p arent m anagem ent training
(E) Resp irations w ill help the fam ily?
(A) Focu sing on m alad ap tive
29. You are treating an 11-year-old boy for op p osi- com m unication in the fam ily
tional d efiant d isord er and have heard from
(B) Focu sing on the fam ily’s interp ersonal
the p arents that his d isord er has had a sig-
relationship s
nificant im p act on the fam ily d ynam ics. They
have tw o old er child ren w ho often feel left (C) Increasing p arental u se of p ositive
ou t and feel d istanced from the fam ily u nit. reinforcem ent to increase d esired
You recom m end a trial of fam ily therap y. behaviors
In this case, w hich of the follow ing w ou ld (D) Interp reting p arent’s negative cognitions
be the m ost ap p rop riate focu s of the fam ily abou t the p atient
therap y? (E) Teaching parents to p ositively refram e a
negative exp erience
(A) Assigning roles in a hou sehold
(B) Early child hood exp eriences 32. A 14-year-old boy w ith attention-d eficit/ hyper-
(C) Im p u lsive behavior activity d isorder (ADH D) is frequently late for
(D) Relationship p atterns school and forgets to d o his chores around the
(E) Unconsciou s conflicts house d ue to his d isorganization. H is parents
are fed up w ith him and ask you w hat they can
30. A 32-year-old man presents for psychother- d o to help change his behavior. Which of the
apy. He denies pervasive depression or anxi- follow ing represents the most helpful behav-
ety symptoms, but he has had a string of failed ioral tool for patients w ith ADH D?

(A) A chart of behaviors to be rew ard ed by
p arents
(B) Aversion therapy
(C) Interp retation of m alad ap tive behaviors
(D) Positively refram ing a negative
exp erience
(E) Pu nishm ent
Questions 33 and 34
A 25-year-old u nm arried m an in his fou rth year of
m ed ical school presents to you r office com p laining
of not being able to rem ain in a relationship w ith
a girlfriend for longer than 3 m onths. H e says that
he w ould like an insight-oriented therap y, and you
agree that this form of therapy w ou ld help him . You
decide to treat this patient with brief psychod ynamic
p sychotherap y.
33. Which of the following factors would best predict
a positive outcome with brief psychodynamic
psychotherapy in this particular patient?
(A) Age
(B) Gend er
(C) Marital statu s
(D) Motivation for change
(E) Socioeconom ic statu s
34. Which of the follow ing asp ects best d istin-
gu ishes his sp ecific typ e of p sychotherap y
from other form s of therap y?
(A) Correcting cognitive errors
(B) Id entification of a focal conflict
(C) Interp reting d ream s
(D) Interp reting resistance
(E) Mod ifying m alad ap tive behaviors
35. A 20-year-old m an is cu rrently in college and
has com p leted the first sem ester of his sop ho-
m ore year. H alfw ay into the second sem ester,
his grad es d rop from As to Fs over a 3-m onth
p eriod . H e becom es increasingly isolated
and p aranoid , believing that the governm ent
is after him becau se he has solved “all theo-
logical p roblem s” throu gh d irect com m u ni-
cation w ith God . H e is started on olanzap ine
10 m g by m ou th (PO) d aily and is tentatively
Que s tions : 27–37 129
d iagnosed w ith schizop hreniform d isord er.
H e recovers after 4 m onths bu t has another
relap se 6 m onths later in the absence of an
elevated , irritable, or d ep ressed m ood . H e is
then given a d iagnosis of schizop hrenia and
referred for m ed ication m anagem ent and
therap y. After a few w eeks of therap y, the
p atient exp eriences a w orsening of his p sy-
chotic sym p tom s. Which typ e of therap y w as
he m ost likely referred to?
(A) Behavioral therap y
(B) Fam ily therap y
(C) Grou p p sychotherap y
(D) Psychoanalytic p sychotherap y
(E) Su p p ortive p sychotherap y
36. A 50-year-old m an is in p sychoanalysis
becau se he feels stagnant in his p ersonal
life. H e notes he is not having any p roblem s
w ith his w ork or relationship w ith his w ife,
althou gh he feels that he has never had m ore
than a p latonic relationship w ith her. While he
feels cap able and confid ent in m ost sp heres
of his life, inclu d ing his relationship s, he feels
like he is at a “road block” in therap y and d oes
not know how to p roceed . H e has, how ever,
m entioned a reoccu rring d ream about his
w ife tu rning into his m other and taking care
of him . The therapist thinks that interpreting
his d ream m ay be a good tool to u se in ther-
ap y. Which of the follow ing u ses of his d ream
w ou ld be the m ost ap p rop riate in this case?
(A) Interp reted by the analyst to
su blim inally influ ence the m ind of the
p atient.
(B) Provid e inform ation abou t p sychic
conflicts.
(C) Rep resent the consciou s fram ew ork for
behavior.
(D) Used to alter cognitive errors.
(E) Used to change behavior.
37. You have been assigned to lead a d ialectical
behavioral therap y grou p for p atients w ith
bord erline p ersonality d isord er. Du ring the
grou p one of the p atients relates a story abou t
getting into a fight w ith her m other. Afterw ard
she w as so d espond ent she had thou ghts