EPPP Part 1 (Examination for Professional Practice in Psychology) — All Questions

A client says, 'I know my drinking is hurting my marriage, and I'm thinking I should cut back at some point, but I'm not ready to do anything yet.' In the transtheoretical model, this client is in which stage?

• a.Precontemplation
• b.Action
• c.Preparation
• d.Contemplation✓

Prochaska and DiClemente described contemplation as awareness of a problem and serious thought about change without a commitment to act. Precontemplation involves no intention to change, preparation involves intending to act soon and taking small steps, and action involves actively modifying behavior.

In motivational interviewing, when a client voices arguments against changing, the clinician's recommended response is to:

• a.Confront the resistance directly and firmly
• b.Present evidence of harm to overcome the client's denial
• c.Warn the client about the consequences of not changing
• d.Reflect the client's ambivalence rather than argue✓

Miller and Rollnick describe arguing for change as the 'righting reflex' that tends to strengthen the client's own counterarguments; motivational interviewing instead uses reflective listening and rolls with sustain talk, drawing out the client's own reasons for change. Presenting evidence to overcome denial, confrontation and warnings are the directive styles the approach was designed to avoid.

Which psychotherapy has the strongest research support as a first-line psychological treatment for obsessive-compulsive disorder?

• a.Thought-stopping techniques
• b.Psychodynamic insight-oriented therapy
• c.Progressive muscle relaxation alone
• d.Exposure and response prevention✓

NIMH states that research shows exposure and response prevention, a specific type of CBT in which a person faces obsession-triggering situations while refraining from compulsions, effectively reduces compulsive behaviors. Insight-oriented therapy, thought-stopping and relaxation alone do not include the exposure-plus-response-prevention component that the evidence supports, and none is the approach NIMH singles out.

Linehan developed dialectical behavior therapy for chronically suicidal clients with borderline personality disorder. The 'dialectic' at the center of the approach balances:

• a.Exposure and flooding
• b.Acceptance and change✓
• c.Reward and punishment
• d.Insight and transference

Linehan (1993) built DBT around the dialectic of accepting clients as they are while pushing for behavioral change, combining behavioral skills with acceptance and mindfulness practices; NIMH describes DBT as a treatment developed for borderline personality disorder. Transference and insight are psychodynamic concepts, flooding is an exposure procedure, and reward and punishment are not the defining dialectic.

In systematic desensitization, a client relaxes deeply while imagining items from a graded fear hierarchy. Wolpe explained its effect through:

• a.Insight into the unconscious origins of the fear
• b.Punishment of avoidance responses
• c.Extinction through prolonged, intense exposure
• d.Reciprocal inhibition✓

Wolpe (1958) proposed that relaxation is physiologically incompatible with anxiety, so pairing it with gradually presented feared stimuli inhibits and weakens the anxiety response: reciprocal inhibition. Prolonged, intense exposure without relaxation describes flooding, insight is a psychodynamic mechanism, and the procedure does not punish avoidance.

In Beck's cognitive model of depression, the 'cognitive triad' refers to negative views of:

• a.The past, the present, and the future
• b.The self, the world, and the future✓
• c.Parents, peers, and romantic partners
• d.Thoughts, feelings, and behaviors

Beck described the cognitive triad of depression as a negative view of oneself, one's experiences in the world, and the future. The past-present-future and relationship lists are not the triad, and thoughts-feelings-behaviors is the general cognitive-behavioral model rather than the depressive content Beck described.

A client says, 'I failed the licensing exam, so I'm completely worthless.' In rational emotive behavior therapy, the therapist's disputing is aimed at:

• a.The emotional consequence of feeling depressed
• b.The activating event of failing the exam
• c.The client's irrational belief about the event✓
• d.The client's early relationships with parents

In Ellis's ABC model, the activating event (A) does not directly cause the emotional consequence (C); the belief (B) about the event does, so disputing (D) targets irrational beliefs such as global self-rating. The failed exam cannot be changed, the emotion is the outcome rather than the target of disputing, and REBT does not focus on early relationships.

Rogers (1957) proposed necessary and sufficient conditions for therapeutic personality change. Which three therapist-provided conditions did he emphasize?

• a.Interpretation, confrontation, and working through
• b.Structure, homework, and contingent reinforcement
• c.Warmth, advice-giving, and frequent self-disclosure
• d.Genuineness, unconditional positive regard, empathy✓

Rogers (1957) held that change follows when the therapist is congruent (genuine), experiences unconditional positive regard for the client, and communicates empathic understanding. Interpretation and working through are psychoanalytic, homework and reinforcement are behavioral, and advice-giving is not among his conditions.

A family therapist maps the family's boundaries, notes an enmeshed mother-son subsystem and a disengaged father, and works to strengthen the parental subsystem. This approach is:

• a.Bowen family systems therapy
• b.Structural family therapy✓
• c.Strategic family therapy
• d.Narrative therapy

Minuchin's structural family therapy assesses family organization in terms of subsystems and boundaries (enmeshed to disengaged) and restructures them, for example by strengthening the parental subsystem. Bowen therapy focuses on differentiation of self across generations, strategic therapy on directives aimed at the presenting problem, and narrative therapy on reauthoring problem-saturated stories.

A therapist's main goals are to increase each family member's differentiation of self and to reduce triangulation, and she uses a three-generation genogram. This approach is:

• a.Solution-focused brief therapy
• b.Bowen family systems therapy✓
• c.Milan systemic therapy
• d.Structural family therapy

Differentiation of self, triangles and multigenerational transmission are core concepts of Bowen's family systems theory, and the genogram is a signature tool. Structural therapy centers on boundaries and subsystems, solution-focused therapy on exceptions and preferred futures, and the Milan approach on circular questioning and hypothesizing.

In a new therapy group, a member says with relief, 'I thought I was the only one who felt this way.' Which of Yalom's therapeutic factors does this reflect?

• a.Catharsis
• b.Altruism
• c.Instillation of hope
• d.Universality✓

Yalom defines universality as the discovery that others share one's problems and feelings, which reduces a sense of isolation. Instillation of hope comes from seeing others improve, catharsis is emotional release, and altruism is the benefit of helping other members.

A school district offers a coping-skills group to every child whose parents are going through a divorce, whether or not the child has symptoms. Under the Institute of Medicine prevention framework, this program is:

• a.Indicated prevention
• b.Selective prevention✓
• c.Universal prevention
• d.Relapse prevention

The Institute of Medicine (1994) classification, drawing on Gordon (1983), defines selective prevention as targeting subgroups at elevated risk, here children of divorcing parents, regardless of symptoms. Universal prevention targets a whole population, indicated prevention targets individuals already showing early signs or symptoms, and relapse prevention concerns people who have already been treated.

A school psychologist consults with a teacher about one student, with the main aim of improving the teacher's own ability to handle similar students in the future. In Caplan's model, this is:

• a.Program-centered administrative consultation
• b.Client-centered case consultation
• c.Consultee-centered case consultation✓
• d.Consultee-centered administrative consultation

Caplan (1970) distinguished client-centered case consultation, where the goal is a plan for the particular client, from consultee-centered case consultation, where the goal is to improve the consultee's skills, knowledge, confidence or objectivity for future cases. The administrative types focus on programs or on staff functioning in an organization's administration rather than a case.

On Holland's RIASEC hexagon, which personality type lies directly opposite, and so is least similar to, the Social type?

• a.Realistic✓
• b.Investigative
• c.Artistic
• d.Enterprising

Holland arranged the types around a hexagon in the order Realistic, Investigative, Artistic, Social, Enterprising, Conventional, with adjacent types most similar and opposite types least similar. Realistic sits opposite Social, Artistic and Enterprising are adjacent to Social, and Investigative is two steps away.

Super's life-span, life-space theory describes career development mainly as a process of:

• a.Responding to a series of chance events and luck
• b.Satisfying needs shaped by early parent-child relations
• c.Implementing a self-concept across life stages✓
• d.Matching a fixed personality type to a work environment

Super described vocational development as implementing one's self-concept through work roles across stages from growth and exploration to establishment, maintenance and disengagement, alongside other life roles. Person-environment typology is Holland's approach, chance-based accounts are separate theories, and needs shaped by early parent-child relations reflect Roe's theory.

In Bernard's discrimination model of clinical supervision, the supervisor moves among which three roles as the supervisee's needs change?

• a.Observer, therapist, and advocate
• b.Evaluator, gatekeeper, and mentor
• c.Coach, parent, and administrator
• d.Teacher, counselor, and consultant✓

Bernard (1979) described the supervisor as shifting among teacher, counselor and consultant roles while attending to three focus areas: intervention, conceptualization and personalization skills. The other lists are not the roles defined in the model.

A client's depression began after she retired and moved to another state, away from her friends and her former work identity. In interpersonal psychotherapy, which problem area would the therapist most likely focus on?

• a.Interpersonal deficits
• b.Role transition✓
• c.Grief
• d.Role dispute

Interpersonal psychotherapy (Klerman, Weissman and colleagues) organizes treatment around four problem areas: grief, role disputes, role transitions and interpersonal deficits. A life change such as retirement and relocation is a role transition; grief concerns a death, role disputes concern conflicts with significant others, and deficits concern chronic social isolation or poor social skills.

Family interventions for schizophrenia often aim to lower a family's 'expressed emotion.' High expressed emotion refers to:

• a.Frequent open expressions of warmth and praise
• b.Criticism, hostility, and overinvolvement✓
• c.The patient's own intense emotional outbursts
• d.Family members' reluctance to discuss the illness

Brown and colleagues and Vaughn and Leff (1976) measured expressed emotion as relatives' critical comments, hostility and emotional overinvolvement, and found that high levels predicted relapse, which led to family psychoeducation aimed at reducing it. Warmth is a separate, protective rating, the construct describes relatives rather than the patient, and reluctance to discuss the illness is not how it is defined.

Bordin's (1979) pantheoretical model of the working alliance identifies which three components?

• a.Transference, countertransference, and the real relationship
• b.Assessment, intervention, and termination
• c.Agreement on goals, agreement on tasks, and the bond✓
• d.Empathy, warmth, and genuineness

Bordin (1979) defined the working alliance as the client and therapist's agreement on the goals of therapy, agreement on the tasks used to reach them, and the emotional bond between them, and argued this applies across therapies. The transference configuration comes from psychodynamic writing, empathy-warmth-genuineness from Rogers' tradition, and the last list describes phases of treatment.