The Nurse Psychotherapist and a Framework for Practice
1. Confidentiality Limits in Psychotherapy: Ethics Checklists for Mental Health Professionals
1. Assessment and Diagnosis
1. The Initial Contact and Maintaining the Frame
1. Cognitive Behavioral Therapy
1. Supportive and Psychodynamic Psychotherapy
1. Stabilization for Trauma and Dissociation
1. Motivational Interviewing
1. Psychotherapeutic Approaches for Addictions and Related Disorders
Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
1. Chapter 1, “The Nurse Psychotherapist and a Framework for Practice”
1. Chapter 3, “Assessment and Diagnosis”
1. Chapter 4, “The Initial Contact and Maintaining the Frame”
1. Chapter 5, “Supportive and Psychodynamic Psychotherapy”
1. Chapter 7, “Motivational Interviewing” (pp.299-312)
1. Chapter 8, “Cognitive Behavioral Therapy”
1. Chapter 13, “Stabilization for Trauma and Dissociation”
1. Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders”
Fisher, M. A. (2016). Introduction. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 3–12). Washington, DC: American Psychological Association. doi:10.1037/14860-001
Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002
1. After informing a prospective patient about limits of confidentiality, the patient consents to the “conditions” of confidentiality and signs an informed consent form. Several weeks later, a lawyer representing the patient’s spouse for a court case, asks the PMHNP for the disclosure of information about the patient. The PMHNP should:
|A.||Disclose all patient information as requested|
|B.||Refuse to disclose any confidential information|
|C.||Limit disclosure to the extent legally possible|
|D.||Ignore the request based on ethical reasons|
1. The PMHNP is meeting with a new patient who is a young veteran back from serving two tours overseas. When reviewing the patient’s health history file that was sent from the VA, the PMHNP learns that several months ago, the patient was diagnosed with PTSD, but never followed up with treatment for it. After a comprehensive mental health assessment, the PMHNP confirms the PTSD diagnosis and understands that which therapeutic approach will be the most effective as a first-line treatment modality?
|A.||Performing a psychiatric debriefing on the patient|
|B.||Employing cognitive behavioral therapy with the patient|
|C.||Using psychodynamic psychotherapy with the patient|
|D.||None of the above|
1. One of the strategies the PMHNP wants to try includes sleep restriction. What will the PMHNP suggest to follow sleep restriction therapy?
|A.||“Restrict sleep for 24 hours.”|
|B.||“Restrict the amount of time you spend in bed.”|
|C.||“Restrict the amount of exercise you do prior to going to bed.”|
|D.||“Restrict the amount of food you eat before bedtime.”|
1. The PMHNP is conducting a peer review of another PMHNP’s medical charts. Upon review, the PMHNP notes that the peer often begins patient sessions late, as well as ends them later than scheduled. The PMHNP also found a comment in the chart regarding the patient sending text messages while in the middle of the session. Based on these findings, the feedback that the PMHNP will provide to the peer involves which therapeutic principle?
|B.||Applying therapeutic communication|
|D.||Maintaining the frame 32.The PMHNP is mentoring a student. After working with a patient during a session, the student laments about all the things she should have, or could have, said to the patient. “I feel guilty that I didn’t speak up more about the patient’s concern toward her son,” says the student. The PMHNP understands that the student is exhibiting signs of which therapeutic concept?|
1. True or false: If after a third round of processing followed by stabilization, a patient has increased anxiety that requires further interventions aimed at stabilization, the therapeutic relationship can no longer successfully provide therapeutic change.
1. The PMHNP has been treating a 15-year-old patient with a history of abuse and neglect. Thirty minutes into their therapy session the patient jumps up and begins to pace around the room. Utilizing Socratic dialogue (SD) the PMHNP’s best action would be to:
|A.||Allow the patient time to process before speaking.|
|B.||Ask, “Why don’t you come have a seat beside me?” while tapping the table.|
|C.||Say, “I noticed a change. Can you tell me what happened?”|
|D.||Say, “We can continue this session later if you prefer.”|
1. The PMHNP is caring for a patient who the PMHNP believes would benefit from a relational psychodynamic approach to therapy. Which action made by the PMHNP demonstrates appropriate use and understanding of the relationship psychodynamic model?
|A.||Focusing the exploration on making the unconscious conscious|
|B.||Focusing the exploration on the genetic roots of the patient’s problem|
|C.||Focusing the exploration on here and now|
|D.||None of the above|
1. The PMHNP is caring for a patient with borderline personality disorder. Using a psychoanalytic psychotherapy approach, the PMHNP attempts to intensify the patient’s transference to enhance emotional processing by:
|A.||Developing increased boundaries|
|B.||Decreasing supportive psychotherapy|
|C.||Scaling back contact with the patient|
|D.||Increasing the number of sessions per week|
1. An elderly patient in a nursing home has been losing interest in activities and now refuses to leave his room. After a physical exam, he is referred to a PMHNP for an initial assessment. True or false: After speaking with the patient, an appropriate screening tool for the PMHNP to use would be the Geriatric Depression Scale.
1. A middle-aged man who works over 50 hours a week is being seen for depression and anger management. He states, “I am even more frustrated when I come home and my wife wants to argue about stupid stuff. All I want to do is come home, take a shower, and eat. Is that too much to ask?” The PMHNP explains that people can be assertive, aggressive, and passive. She encourages the patient to be more assertive and begins role-play with assertive training. The PMHNP determines that the patient is beginning to understand when he states:
|A.||“I am tired, I work very hard all day to support you and this family!”|
|B.||“I come home and all you do is argue, but I don’t care.”|
|C.||“I don’t know what I did. Why are you acting like this?!”|
|D.||“I feel frustrated when I come home and we argue.”|
1. The PMHNP is treating a patient with a substantial fear of feeling closed in (claustrophobia). Thus, the patient will not get into an elevator. The office where he works is on the 10th floor and this requires that he walk up and down the stairs in the morning and evening to get to his office. With permission from the patient, the PMHNP is beginning systematic desensitization to address the patient’s need to use the elevator. What is the PMHNP’s best plan of action?
|A.||Begin by having the patient stand in front of the elevator and write down his feelings|
|B.||Complete a 30-minute therapy session in an elevator|
|C.||Allow the patient to watch an elevator go up and down|
|D.||Allow the patient to see the PMHNP getting into an elevator|
1. A PMHNP is assessing ego functioning of his 40-year-old patient by asking what she feels is the cause of her problems. She attributes her problems to her overprotective parents not letting her have enough freedom growing up. Based on her answer, the PMHNP is testing _____________.
|A.||adaptive regression in the service of the ego|
|B.||regulation and control of affects and impulses|
|C.||defensive and interpersonal functioning|
|D.||sense of reality of the world and of the self|
1. The PMHNP meets with a 47-year-old male patient who is fearful of leaving the house after having witnessed his neighbor getting run over by a car. When the PMHNP asks why he is afraid to leave his house, the patient replies, “Because another accident might occur.” Which cognitive behavioral therapy (CBT) strategy does the PMHNP employ?
|B.||Stress inoculation therapy|
|C.||Dialectical behavior therapy|
|D.||All of the above|
1. A 62-year-old patient has been diagnosed with borderline personality disorder. Upon assessment, the PMHNP learns that he participates in spending sprees and occasional binge eating, accompanied by rapid changes in self-image. Which evidence-based psychotherapeutic model does the PMHNP identify as effective and beneficial?
|A.||Cognitive behavioral therapy|
|C.||Dialectical behavior therapy|
1. The PMHNP is working with a patient who witnessed her father pass away after suffering for several months from terminal cancer. The PMHNP sees this as a traumatic event. The patient reports sometimes feeling out of touch with surroundings; almost as if things feel like a dream. “Sometimes that sensation lingers for a while,” the patient says, “and other times I snap out of it quickly.” What does the PMHNP infer about the condition based on psychotherapy concepts for trauma?
|A.||The patient is having a balanced response to the trauma.|
|B.||The patient is reporting signs of dissociation.|
|C.||The patient is becoming unresponsive to the environment.|
|D.||All of the above.|
1. The patient is a 56-year-old female patient diagnosed with panic disorder and reports symptoms that include heart palpitations, frequent trembling, and feelings of choking in stressful situations. What special consideration does the PMHNP make?
|A.||Using a special focus on transference as the agent promoting change|
|B.||Confronting the emotional significance of the patient’s symptoms|
|C.||Employing psychodynamic therapy combined with pharmacotherapy|
|D.||A and B|
1. The PMHNP is meeting with a 38-year-old divorced, single mother who has been seeing the PMHNP for anxiety and anger management. During one of the sessions, the patient tells the PMHNP that she is having a problem getting her child support payments from her ex-husband, which is triggering increased anxiety and anger, which she admittedly takes out on her children. How does the PMHNP respond in a way that upholds the supportive psychodynamic psychotherapy approach?
|A.||Telling the patient to take a vacation to get away and relax|
|B.||Suggesting that she seek legal help|
|C.||Giving her advice about men and how to get them to pay child support|
|D.||Suggesting that the patient start going to church to help find more solace.|
1. During a session, the PMHNP asks a patient with a history of sexual abuse to recall the relationship she had as a child with her parents. The patient responds by saying she has a headache and her stomach hurts, and starts talking about her physical ailments. What is the appropriate response by the PMHNP?
|A.||Assure the patient that she does not have to discuss these memories|
|B.||Explain why it is important for the patient to discuss these memories openly|
|C.||Tell the patient that she may not get better if she does not face her fears|
|D.||Let the patient know that plenty of other people have similar painful memories, too|
1. The PMHNP is working with an adult patient who has somatic complaints caused by a history of childhood abuse. As part of the therapeutic process, what does the PMHNP do to assess and organize a trauma history?
|A.||Interview the patient’s family members|
|B.||Construct a timeline of the patient’s life|
|C.||Review the patient’s current stressors|
|D.||Debrief with the patient|
1. During a therapy session with an 18-year-old female the PMHNP learns that she has lived in six different foster homes in the last 24 months. She states that her mother is in a correctional facility for drug abuse and prostitution. During the assessment, the PMHNP notices multiple superficial cuts to each wrist. The patient appears tearful, withdrawn, and never makes direct eye contact. The PMHNP believes that this patient may have feelings of insecurities as well as abandonment issues and is aware that which diagnosis is likely possible?
|A.||Narcissistic personality disorder|
|B.||Obsessive-compulsive personality disorder|
|C.||Borderline personality disorder|
|D.||Paranoid personality disorder|
1. A patient named Steve is seeking therapy to get help with his home situation, stating that he has been stressed since his mother-in-law moved into the house. What can the PMHNP do to assist the patient in constructing a narrative?
|A.||Share a personal story about her home situation and family members|
|B.||Elicit details so Steve becomes more self-disclosing and self-examining|
|C.||Guide Steve through imagery exercises so he can decrease his stress|
|D.||None of the above|
1. A 16-year-old female patient has had a stable therapeutic relationship with the PMHNP for several months. The PMHNP notices what appears to be fresh cigarette burns on the patient’s arm. When asked, the patient admits to this self-injurious behavior. Although the patient is still depressed, her mood seems to be somewhat better this week. True or false: The PMHNP would most likely consider this patient stabilized and ready to move to Stage II.
1. The PMHNP is working with a patient who experiences abreactions when discussing repressed feelings of his sexual abuse as a child. What can the PMHNP do to manage the patient’s intense emotional reactions?
|A.||Sit closer to the patient so the patient does not feel isolated|
|B.||Embrace the patient to provide physical comfort|
|C.||Suggest a relaxation technique, such as yoga or meditation|
|D.||All of the above|
1. A PMHNP has been working with a young female patient who suffers from depression to change self-defeating behaviors. By creating a presence of acceptance and using good listening skills, the PMHNP’s overall goal is to __________.
|A.||deepen the patient’s understanding of herself in order to cultivate empowerment|
|B.||slowly transfer authority to the patient when the PMHNP feels that she is ready|
|C.||remain caring, yet authoritative by making important decisions for the patient|
|D.||all of the above|
1. During cognitive behavioral therapy (CBT), a 64-year-old male patient states, “I get so frustrated sometimes and I just blow up at everybody!” Which response by the PMHNP demonstrates translation of Socratic dialogue (SD)?
|A.||“Please explain how this affects the relationship with your wife.”|
|B.||“When you say blow up, what exactly does blow up mean and how does it feel to you?”|
|C.||“What coping methods have you used in the past during times of frustration?”|
|D.||“So you blow up when you become frustrated?”|
1. The PMHNP is mentoring a student. After working with a patient during a session, the student laments about all the things she should have, or could have, said to the patient. “I feel guilty that I didn’t speak up more about the patient’s concern toward her son,” says the student. The PMHNP understands that the student is exhibiting signs of which therapeutic concept?
1. A 28-year-old male patient is experiencing distress related to the workplace. What might the PMHNP ask to assess affective development?
|A.||“How do you think your colleagues feel about you?”|
|B.||“How do you calm yourself when you are upset at the office?”|
|C.||“How do you think your colleague felt when you blamed her?”|
|D.||All of the above.|
1. A PMHNP is preparing confidentiality forms for his patients. What is the most appropriate first step he should take?
|A.||Talk to potential patients to get their feedback and suggestions|
|B.||Research his profession’s ethics code and state/federal laws|
|C.||Use current patient interactions to decide what matters most|
|D.||All of the above|