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Chapter 16: Psychological Treatment LEARNING GOALS 1. Be able to explain standards for studies on psychotherapy and the gaps in the generalizability of treatment outcome research. 2. Be able to discuss issues with adapting psychotherapies for people from diverse ethnic and cultural backgrounds. 3. Be able to identify the specific types of psychological treatments that have empirical support, and issues that clinicians must consider in applying these treatments. 4. Be able to describe different approaches to integrating psychotherapies and identifying common elements across treatments. 5. Be able to discuss the goals of community psychology and political trends in that field. Summary Challenges in Evaluating Treatment Outcomes ● Research on the effectiveness of various forms of psychological treatments has been conducted for many decades. Overall, this research suggests that about 75 percent of people gain some improvement from therapy. Therapy also seems to be more helpful than a placebo or the passage of time. ● Efforts have been made to define standards of research on psychotherapy trials and to summarize the current state of knowledge on which psychological treatments work. These standards typically include the need to randomly assign participants to treatment or a control, to use a treatment manual, to define the treated sample carefully, and to use reliable and valid outcome measures. It is hoped that these efforts will help disseminate the best available therapeutic practices to clinicians and their clients, as well as provide insurance companies with the data to support the use of psychotherapy. ● Controversy exists about the research standards. A large portion of clients are excluded or will not take part in clinical trials, cultural diversity is lacking in most trials, many treatment approaches remain untested, and treatment manuals can constrain a talented therapist. A broader concern is that a huge gap exists between what happens in the research world and the real world. Efficacy research focuses on how well therapies work in carefully controlled experiments, whereas effectiveness research focuses on how well therapies work in the real world. The Importance of Culture and Ethnicity in Psychological Treatment ● Clinicians offering treatment to minority individuals must be sensitive to the values and political events that shape the way people may approach relationships, therapy, and emotional expression. Little empirical research is available on how psychotherapies work for people from diverse backgrounds, but minority status is associated with less use of therapy. Researchers have developed modifications of some treatments to be more culturally sensitive. Specific Treatment Approaches: Issues and Treatment Outcome Research ● Experiential psychotherapies, based on humanistic and existential psychology, emphasize the freedom to choose, personal growth, and personal responsibility . Variants of these approaches include Rogers’ client-centered therapy, existential therapy, Gestalt therapy, and emotion-focused therapy. ● Treatment outcome research supports the efficacy of psychodynamic, experiential, and cognitive behavioral approaches compared to no treatment or treatment controls. Behavioral approaches offer a clear advantage for the treatment of anxiety and may be slightly more helpful than experiential approaches in other disorders. Generally, the literature on how these different active forms of psychotherapy compare to each other is quite limited. ● Cognitive behavioral treatments have evolved over the past 10 years, and several manuals incorporate broader themes such as spirituality and meaning. Although there is less research available, the research findings about cognitive behavioral treatments are promising. ● Marital or couples therapy helps distressed couples resolve the inevitable conflicts in any ongoing relationship of two adults living together. Behavioral therapies are clearly better than no treatment, but within a matter of a couple years, at least half of couples return to significant distress. Promising evidence exists for integrative behavioral marital therapy and insight-oriented marital therapy as compared to standard behavioral marital therapy. ● Family therapy includes many different techniques. These therapies have been shown to be particularly successful in the treatment of externalizing disorders in children and adolescents, in helping people with substance abuse accept the need for treatment, and in reducing relapse in adults with schizophrenia and bipolar disorder. Psychotherapy Integration ● There are three different approaches to therapy integration: technical eclecticism, theoretical integration, and common factorism. Technical eclecticismrefers to borrowing techniques from other approaches while maintaining a focused conceptual approach. Theoretical integration is exemplified by Wachtel’s cyclical psychodynamics, or by the recent inclusion of a focus on acceptance within cognitive behavioral therapies. Common factors research identifies variables that predict outcomes across a broad range of therapies, such as the quality of the therapeutic alliance or therapist empathy. Community Psychology ● Community psychology aims primarily at the prevention of disorder on a large-scale. Political issues have shaped the popularity of this approach. 1. Which of the following statements are true? a. Generally speaking, psychotherapy is effective. b. Less than 25% of people who enter psychotherapy treatment improve. c. Psychotherapy is more effective with women and children than with men. d. Outcome research is designed specifically to find the best treatment for Axis II disorders. Answer: A Type: Factual Page: 530 2. Research shows that people who enter psychotherapy show improvement a. most of the time. b. about half the time. c. most of the time if their problems are minor. d. equal to the support of good friends. Answer: A Type: Factual Page: 530 3. A no-treatment control group allows researchers to test which of the following? a. whether random assignment is effective. b. whether the data is valid. c. whether the passage of time helps a person recover as much as the active treatment does. d. whether the data is reliable. Answer: C Type: Factual Page: 530 4. Most treatments on the APA task force list of empirically supported treatments are a. rational-emotive. b. cognitive-behavioral. c. interpersonal. d. psychodynamic. Answer: C Type: Factual Page: 531 5. By current standards, in order to receive grant funding for treatment outcome research in psychotherapy, a researcher must a. have a therapy manual. b. have access to licensed therapists. c. be affiliated with a medical school. d. be familiar with psychopharmacological agents. Answer: A Type: Factual Page: 532 6. Manuals in psychotherapy outcome research provide greater internal validity meaning that a. the within-study results are more reliable. b. researchers can more confidently attribute results to the specific treatment offered. c. researchers can confidently generalize results to psychotherapy practiced outside of the controlled study. d. researchers can specify the exact mechanism of change. Answer: B Type: Factual Page: 532 7. Therapy conducted using a manual has ______ internal validity and_____ external validity. a. high; high b. high; low c. low; high d. low; low Answer: B Type: Factual Page: 532 8. Therapy manuals are used to ensure that therapists use a. procedures tailored to the individual. b. optimal procedures in therapy. c. the same procedures in research. d. procedures validated by research. Answer: C Type: Factual Page: 532 9. Theoretically, the use of manuals a. does little to account for differences in therapists. b. controls for different levels of therapist skill. c. is only appropriate during a randomized clinical trial. d. None of the above are correct. Answer: B Type: Factual Page: 532 10. The purpose of treatment manuals is to a. clearly define the independent variable. b. allow for greater external validity. c. limit the amount that therapists vary in how they deliver the treatment. d. Both a and c are correct. Answer: D Type: Factual Page: 532 11. A problem with the use of treatment manuals is a. the client may feel that his or her particular concerns are not being addressed. b. they do not provide good internal validity. c. they are often convoluted and difficult to follow. d. they are only useful for psychodynamic research. Answer: A Type: Factual Page: 532 12. Tom feels that he meets criteria for social phobia. He learned of these symptoms from ads for a free trial of therapy. He decides he would like to participate in the study. Tom might be excluded from participating in the study if he a. is depressed because of his social phobia . b. smokes cigarettes. c. also has post-traumatic stress disorder. d. has a relative with social phobia. Answer: C Type: Applied Page: 533 13. When a researcher determines that the outcome of a randomized controlled treatment study on schizophrenia is associated with reduction in negative symptoms, he or she is referring to the________ of the treatment. a. effectiveness b. efficacy c. positive effects d. grant-funded nature Answer: B Type: Applied Page: 533 14. When considering the outcome of therapy trials, who is in the best position to determine effectiveness? a. the client b. the therapist c. the grant-funding agency d. the research assistants Answer: A Type: Factual Page: 533 15. The advent of managed care has changed what aspect of practice for psychologists? a. theoretical orientation b. focus on underlying causes c. accountability d. efficacy Answer: C Type: Applied Page: 534: Focus on Discovery 16.1 16. Yoshi is receiving therapy for social phobia. As part of therapy, he is instructed to imitate a series of target behaviors demonstrated by his therapist. Yoshi will be best able to model these behaviors if a. the therapist is of the opposite sex. b. his symptoms are mild. c. the therapist has cultural competence d. All of above are correct. Answer: C Type: Applied Page: 535 17. Cultural competence refers to whether therapists a. are effective within their own culture. b. understand the culture of their clients. c. are certified in the study of cultures. d. come from a similar culture to their clients. Answer: B Type: Factual Page: 535 18. Which of the following factors may be more important in contributing to good outcomes in therapy than ethnic matching? a. agreement on theoretical orientation between therapist and client b. same age bracket for therapist and client c. same gender for therapist and client d. cultural competence Answer: D Type: Factual Page: 535 19. African American patients a. are less satisfied with ethnically-similar therapists. b. have likely experienced prejudice. c. will inevitably run into insurmountable barriers in therapy. d. All of the above are correct. Answer: B Type: Factual Page: 536 20. The text urges white therapists working with Latino clients to be especially sensitive to which of the following cultural issues? a. personal and family losses. b. importance of religion. c. anger at majority culture. d. respect for authority. Answer: B Type: Factual Page: 536 21. Which of the following is a characteristic of Asian Americans? a. They tend to talk about stress in psychical terms. b. They do not experience discrimination like other ethnic minorities. c. They are individualistic people. d. All of the above are correct. Answer: A Type: Factual Page: 536 22. Unlike other cultural groups, Asian Americans may a. feel more shame regarding the necessity of therapy. b. feel that some areas are 'off-limits' in therapy. c. identify a need for greater formalities in treatment. d. All of the above are correct. Answer: D Type: Factual Page: 536 23. Tim is a Native American child in therapy for ADHD. He frequently avoids eye contact with his therapist. This is likely a sign of a. low self-esteem. b. shame about therapy. c. respect. d. guilt. Answer: C Type: Applied Page: 537 24. Empirically supported treatments for specific minority groups a. have not been effective. b. are overwhelmingly psychodynamic. c. rarely include a control group. d. are few and far between. Answer: D Type: Factual Page: 538 25. According to Duran (2004), culturally sensitive interventions may need to be modified to change a. the role of the therapist. b. the types of intervention strategies used. c. the content of the intervention and how to present aspects of the content. d. All of the above are correct. Answer: D Type: Factual Page: 538 26. The major goal of psychoanalytic approaches to therapy involves a. removal of repressions. b. the interplay of behavioral events and internal attributions. c. identifying associations between unconscious motivations and superego functioning. d. determining accurately the operative defense mechanisms. Answer: A Type: Applied Page: 539 27. Psychoanalysis primarily focuses on a. presenting symptoms. b. unconscious conflicts from earlier in life. c. cognitive biases associated with neuroticism. d. None of the above are correct. Answer: B Type: Factual Page: 539 28. If two different people were in therapy, one seeing a traditional psychoanalyst and one seeing a more contemporary psychodynamic therapist, you would a. be able to decipher who saw which kind of therapist from their descriptions of the clinicians. b. have difficulty deciphering who saw which kind of therapist from their descriptions of the clinicians. c. see a greater focus on childhood from the contemporary psychodynamic therapist. d. find the traditional psychoanalyst to be more emotionally invested than the contemporary psychodynamic therapist. Answer: B Type: Applied Page: 539 29. A major problem of outcome research in psychoanalytic therapy is a. methodological flaws. b. the large number of studies makes it difficult to determine for whom therapy is best suited. c. the low education level of most of the study participants. d. All of the above are problems in outcome research on psychoanalytic therapy. Answer: A Type: Applied Page: 540 30. One problem with studying outcomes of brief psychodynamic treatments is a. evaluating transference effects. b. comparing them to lengthier approaches. c. the lack of agreed treatment manuals. d. which approaches to include. Answer: D Type: Factual Page: 540 31. Sara is in psychoanalytic therapy. She will do best in treatment if a. she is well educated. b. she has schizophrenia. c. she is middle-aged. d. All of the above factors will be associated with better outcome. Answer: A Type: Applied Page: 540 32. Client-centered therapy suggests a. problems arise from inner disturbance associated with ego-conflicts. b. disorders are a result of failing to attend to one's own experiences.. c. psychological problems arise from interpersonal difficulties exclusively. d. cognitive errors create neurotic disturbance. Answer: B Type: Factual Page: 541 33. Sandra is a graduate student in clinical psychology. As part of her training, she is encouraged to develop good listening skills and unconditional positive regard, exhibit empathy and genuineness, and hold clients in a positive light. These are all central features of which therapeutic paradigm? a. psychodynamic b. cognitive c. behavioral d. client-centered Answer: D Type: Applied Page: 541 34. Lucy is currently a patient and a subject in a psychotherapy outcome study being run by a Rogerian therapist. Lucy is most likely to a. complete self-report questionnaires about herself, have her family interviewed, and have a medical exam. b. be self-actualized. c. have her functioning rated by her family and friends only. d. suffer from severe psychopathology. Answer: B Type: Applied Page: 541 35. Which of the following therapies emphasize the notion that each of us are ultimately alone in the world and that we must create our own existence? a. existential b. client-centered c. Gestalt d. psychoanalytic Answer: A Type: Factual Page: 541 36. In which of the following ways are gestalt therapy and client-centered therapy similar? a. Both emphasize inner conflict as the root cause of psychological disturbance. b. Each encourage structured behavioral exercises to alleviate inner distress. c. Both focus on an innate goodness in the client. d. None of the above are correct. Answer: C Type: Applied Page: 541-542 37. In Gestalt therapy, a “here and now” focus refers to a focus on a. events in the session. b. the therapeutic alliance. c. the client’s current life. d. reactance. Answer: A Type: Factual Page: 542 38. Alison is in therapy with a Gestalt therapist. As part of therapy, she is asked to imagine that her mother is in the room, and she is instructed to communicate to her how she feels, while gazing at a seat in the room. This is also known as the a. empty-chair technique. b. enacted interaction method. c. analogue interaction. d. accurate empathy. Answer: A Type: Applied Page: 543: Focus on Discovery 16.2 39. Gestalt therapy is widely recognized for its a. extensive theoretical basis. b. reliance on validated principles. c. creative therapy techniques. d. research on therapy outcome. Answer: C Type: Factual Page: 543: Focus on Discovery 16.2 40. Emotion-focused therapy focuses on a. the client’s emotional reaction to discussing his or her childhood. b. what is happening at that exact moment. c. the most important event in the client’s life. d. maladaptive emotions. Answer: D Type: Factual Page: 542 41. Timbo is in therapy for depression. Timbo’s therapist is trying to get him to recognize that some of his emotions are adaptive, while other emotions are maladaptive. Timbo is most likely being treated by a therapist who practices a. client-centered therapy. b. Gestalt therapy. c. emotion-focused therapy. d. brief psychodynamic therapy. Answer: C Type: Applied Page: 542 42. Outcome research on experiential approaches has indicated that a. experiential therapies are more likely to relieve symptoms of less severe problems. b. experiential therapies are more likely to relieve symptoms of more severe problems. c. these therapies are largely ineffective in relieving symptoms of anxiety or depression. d. exposure is a very effective approach for treating anxiety disorders. Answer: A Type: Factual Page: 542 43. Operant techniques have been effective in treating symptoms of a. depression. b. substance abuse. c. childhood behavior problems. d. All of the above are correct. Answer: D Type: Factual Page: 544 44. In which area have operant methods been especially effective? a. self-help programs. b. for low-income people. c. depression. d. for children. Answer: D Type: Factual Page: 544 45. Which technique has been especially successful in the treatment of many problems of children? a. client-centered b. operant c. cognitive d. Children are hard to treat with any technique. Answer: B Type: Factual Page: 544 46. A behavioral treatment for school phobia is to reinforce school attendance by throwing a party every day the child attends school. Later the parties are dropped while making sure that classroom activities are reinforcing. Switching to classroom activities is a behavioral technique for a. behavioral activation. b. easing termination. c. maintaining gains. d. documenting success. Answer: C Type: Factual Page: 545 47. Owen cannot get to sleep at night. He discusses it with his therapist who tells him that he must try to keep himself awake all night. This is an example of a. Gestalt therapy. b. motivational interviewing. c. stepped care. d. a paradoxical intervention. Answer: D Type: Applied Page: 546: Focus on Discovery 16.3 48. Tina is being treated for a spider phobia. Her therapist instructs her to become more anxious about spiders, and she actually becomes less anxious. Tina’s response is an example of a. paradoxical intervention. b. self-efficacy. c. reactance. d. ego control. Answer: C Type: Applied Page: 546: Focus on Discovery 16.3 49. Motivational Interviewing was originally developed for a. schizophrenia. b. substance abuse. c. couples therapy. d. depression. Answer: B Type: Factual Page: 546 Focus on Discovery 16.3 50. According to rational-emotive behavior therapists, a. irrational beliefs are any ideas that are not objective. b. irrational beliefs must be constructed on empirical grounds. c. emotional distress comes from demanding perfection from oneself and relationships. d. None of the above are correct. Answer: C Type: Factual Page: 547 51. Cognitive therapy, according to Beck, suggests a. that people make assumptions about their lives that lead to distress. b. that schemas control unstated verbalizations leading to distress. c. that cognitive biases maintain negative beliefs about oneself and the world. d. All of the above are correct. Answer: D Type: Applied Page: 547 52. Beck's cognitive therapy and Ellis' rational emotive behavior therapy differ in that a. Beck favors using adjectives like irrational or nutty. b. Ellis' methods are ground more in scientific methods. c. Ellis’ approach is more didactic; he often uses mini-lectures. d. Beck believes that forceful interventions are needed to disrupt well-learned thought patterns. Answer: C Type: Factual Page: 547 53. Henry is a recovering alcoholic and has been sober for the past four months. After hearing about the death of his close friend, Henry finished a bottle of red wine. According to Marlatt, Henry’s “slip” will not result in him returning to alcoholism if a. Henry makes a pact with his therapist never to drink again. b. Henry blames his own weaknesses for the relapse. c. Henry considers the death of his friend as an external factor that drove his relapse. d. his therapist reprimands him. Answer: C Type: Applied Page: 548 54. The third wave of cognitive behavioral therapy can be characterized by a. a strict behavioral approach. b. a strict cognitive approach. c. incorporating focus on spirituality and acceptance. d. incorporating operant conditioning techniques. Answer: C Type: Factual Page: 549 55. What is the name of the recent cognitive behavioral technique in which people are encouraged to be highly aware of their emotions without acting impulsively on them? a. unconditional regard b. response inhibition c. schemas d. mindfulness Answer: D Type: Factual Page: 549 56. Incorporating spirituality, values, emotion and acceptance into CBT a. is a hallmark of the third wave of cognitive behavioral therapy. b. is known as emotion-focused therapy. c. have been found to be ineffective in reducing depression symptoms. d. characterizes the first wave of cognitive behavioral therapy. Answer: A Type: Factual Page: 549 57. Empirical work evaluating the outcome of cognitive therapy a. universally supports cognitive therapy as superior to medication. b. suggests that CBT is as effective as medication in treating severe depression. c. by and large shows medication to be a more effective treatment than cognitive therapy. d. rarely compares the therapy to a medication group. Answer: B Type: Factual Page: 549 58. Investigators hypothesize that CBT may help to prevent future episodes of depression because a. it teaches clients coping skills they can use even after therapy ends. b. it teaches clients how to think about negative childhood experiences in a more positive way. c. it helps clients come to terms with their own imperfections. d. it promotes healthy relationships among friends and co-workers. Answer: A Type: Factual Page: 549 59. Changes in patients’ cognitions a. are seen in patients treated with cognitive therapy. b. are seen in patients treated with medication treatment. c. Both a and b are correct. d. Neither a nor b is correct. Answer: C Type: Factual Page: 549 60. In the demand-withdraw cycle, a. one partner has the tendency to make large demands on the other and then quickly withdraws his or her requests resulting in conflict. b. one partner attempts to discuss a problem and the other withdraws from the discussion. c. men are usually in the “demanding” role, and women are in the “withdrawing” role. d. the therapist trains one partner to be more demanding and the other to be more withdrawing based on their respective personalities. Answer: B Type: Factual Page: 550 61. Couples therapists often use videotapes to a. show couples how they interact. b. give couples homework assignments. c. study complex couple interactions. d. remind couples of good times together. Answer: A Type: Factual Page: 550 62. Fred and Jana are experiencing distress in their relationship. They will do best in treatment if a. Fred and Jana are both depressed and seek individual therapy for their depression. b. one is anxious regarding treatment outcome for the relationship. c. they are seen for treatment together. d. they do not have children. Answer: C Type: Factual Page: 550 63. Which of the following statements is true? a. Outcome research on couple’s therapy suggests that about 75% - 80% of treated couples are happily married at the end of treatment. b. In many studies, behavioral couple’s therapy has been shown to better relieve relationship distress than no treatment or placebo-treatment. c. Psychodynamic couple’s therapy has been shown to be more effective than behavioral couple’s therapy. d. When there is distress in a relationship, couples are usually better off if they seek individual therapy, at least initially. Answer: B Type: Factual Page: 551 64. A recent development in behavioral couples therapy has been a. acknowledging divorce. b. a growing appreciation of the role of acceptance. c. a resurgence of traditional breadwinner/homemaker models. d. revisiting past conflicts in vivo with the therapist. Answer: B Type: Factual Page: 552 Focus on Discovery 16.5 65. Acceptance in behavioral couple’s therapy a. emphasizes simultaneous encouragement of change. b. does not promote resignation. c. seeks to promote greater closeness and intimacy. d. All of the above. Answer: D Type: Factual Page: 552: Focus on Discovery 16.5 66. A recent modification to behavioral marital therapy involves a. reinforcing the partner for negative behaviors, as in paradoxical interventions. b. accepting, and even embracing, certain negative behaviors. c. providing compliments. d. ignoring problem behaviors and focusing upon positive behaviors. Answer: B Type: Factual Page: 552: Focus on Discovery 16.5 67. Family therapy a. emphasizes that usually one family member causes the majority of the problems. b. has not been shown to be effective in treating the symptoms of bipolar disorder or schizophrenia. c. is based on the notion that improving parental monitoring and discipline will help the family unit. d. is based on the idea that the problems of the family influence each member and that the problems of each member influence the family. Answer: D Type: Factual Page: 554 68. The primary focus of technical eclecticism is a. to establish interventions that work from other therapy orientations, but conceptualize it from a singular paradigm. b. an effort to determine interventions that all schools of therapy share. c. an effort to ultimately blend theories into one coherent paradigm. d. an effort to bind all treatments to a single therapy school. Answer: A Type: Factual Page: 555 69. A therapist who practices technical eclecticism a. fails to identify incompatibilities in techniques. b. uses whatever technique works. c. integrates various theories in therapy. d. attempts theoretical integration prematurely. Answer: B Type: Factual Page: 555 70. The approach to therapy espoused by Lazarus encourages a. using multiple techniques to solve a client’s problems. b. focusing largely on cognitions and behavior. c. selecting items from a menu of distressing behaviors to focus treatment upon. d. determining unconscious factors and establishing biological links. Answer: A Type: Factual Page: 555 71. Lazarus’ approach to treatment was one of the first to use a. eclecticism. b. a distinct multi-axial system. c. integration. d. None of the above are correct. Answer: A Type: Factual Page: 555 72. Dr. Swanson reviews the literature on psychotherapy to find what aspects of therapy are found in all major theories of psychotherapy. He is researching a. eclecticism. b. common factors c. integrationism. d. multimodal psychotherapy. Answer: B Type: Applied Page: 556-557 73. The work of Paul Wachtel is an example of a. eclecticism. b. common factorism. c. integrationism. d. multimodal psychotherapy. Answer: C Type: Factual Page: 556 74. Wachtel aimed to integrate a. behavior therapy and cognitive therapy. b psychoanalysis and interpersonal therapy. c. behavior therapy and psychoanalysis. d. interpersonal therapy and cognitive therapy. Answer: C Type: Factual Page: 556 75. The idea that people’s repressed problems are both expressed in and maintained by current behavior is an example of a. contemporary psychodynamic theory. b. traditional psychoanalytic theory. c. psychodrama. d. cyclical psychodynamics. Answer: D Type: Applied Page: 555 76. Whose theoretical position is illustrated by the following? Marta struggled with her college classes. She sought therapy where she learned better study skills. As a result, her grades improved. As they did so, she began to realize her anger at her parents who had never praised her childhood accomplishments. a. Lazarus b. Perls c. Bandura d. Wachtel Answer: D Type: Applied Page: 556 77. Saul, in treatment for anger, has found that anger control methods have helped him function at work and in relationships better. However, he has also found that identifying the early childhood origins of his anger have helped him feel less anger overall, and the need to control it has diminished. He has accomplished this with the same therapist. This is an illustration of a. cognitive therapy. b. brief psychodynamic therapy. c. psychotherapy integration. d. family therapy. Answer: C Type: Factual Page: 555 78. Early in therapy, Tom has found that he enjoys meeting with his therapist. The two seem to be working toward a common goal, and the time appears to go quickly. This would characterize a good a. rapport. b. initial symptom reduction. c. process. d. therapeutic alliance. Answer: D Type: Applied Page: 557 79. A strong therapeutic alliance a. is what produces the majority of change in therapy. b. results when patients’ symptoms improve. c. is rare. d. None of the above are correct. Answer: D Type: Factual Page: 557 80. Therapists who can ______________ will be able to promote stronger therapeutic relationships. a. clearly articulate their theoretical orientation to their clients b. convey empathy and positive regard c. set strict guidelines d. All of the above are correct. Answer: B Type: Factual Page: 557 81. When Jacobson and colleagues offered only the behavioral activation portion of cognitive therapy, a. they achieved much worse results than cognitive therapy alone. b. they achieved similar results to cognitive therapy alone. c. clients reported feeling greater self-efficacy. d. a stronger therapeutic relationship was established. Answer: B Type: Factual Page: 558 82. As part of therapy, Edith begins to experience control over purging by only purging following lunch, rather than at random. Her ______________ was/were increased in therapy. a. symptoms b. reactance c. assertion d. self-efficacy Answer: D Type: Applied Page: 558 83. Bandura suggests that to the extent that they are effective, all therapeutic procedures are effective by a. giving the person a sense of self-efficacy. b. promoting a strong therapeutic alliance. c. teaching the person coping skills. d. making the person feel understood. Answer: A Type: Factual Page: 558 84. Recently, researchers have called for more research on empirically-supported _____________ rather than empirically-supported treatments. a. behavioral therapies b. principles of action c. principles of change d. medication regimes Answer: C Type: Factual Page: 558 85. Which of the following has made it difficult to evaluate the effectiveness of community psychology? a. The goals of community psychology remain unclear. b. Few people in a community seek psychotherapy. c. Difficulty in establishing experimental controls. d. Social forces that led to this approach have changed. Answer: C Type: Applied Page: 559 86. Community psychology, unlike other forms of therapy, focuses on a. seeking those who most need therapy. b. those who seek therapy. c. political activism as a means of accomplishing community change. d. YAVIS clients. Answer: A Type: Applied Page: 560 87. Which is a likely cause for the decline in community psychology emphasis? a. high cost of community care b. growth of urban centers c. changing social values d. poor research results Answer: C Type: Factual Page: 560 88. Community psychology primarily concerns itself with a. developing clinics that provide individual therapy. b. larger scale efforts at intervention and wellness. c. programs based in community hospitals. d. All of the above are part of community psychology. Answer: B Type: Applied Page: 559 Essay Questions 1. Describe some differences between how therapy research is conducted versus the typical practice of therapy. 2. Discuss the cultural factors involved in treatment for each of the following cultural groups: African Americans, Latinos, Asian Americans, and Native Americans. 3. Compare and contrast Ellis’ Rational-Emotive Behavior Therapy with Beck’s Cognitive therapy. 4. How are client-centered and Gestalt therapies similar and different? 5. What have been some of the limitations in community psychology interventions, and how might these limitations be overcome? 6. Describe the three different approaches to eclecticism (technical eclecticism, common factorism, theoretical integration). 7. Describe the work of Paul Wachtel. What can psychodynamic therapists learn from him? What can behavior therapists learn from him? 8. What are the conclusions from treatment outcome studies of couples therapy? 9. Discuss the aims of community psychologists and the types of programs they develop. What are the difficulties in evaluating community psychology programs?