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Flashcards by chapter
556 cards for the 34 chapters of The NCE Mastery Guide. Read the front, say the answer out loud, then open the card to check yourself. Sort the ones you missed into a "not yet" pile and come back to them.
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Chapter 1 Professional Identity and the Ethical Core
Ch. 1 · 1 Licensure vs. certification vs. accreditation Show answer
Licensure: state board, mandatory, individual. Certification: professional body (e.g., NBCC’s NCC), voluntary, individual. Accreditation: CACREP, programs only.
Ch. 1 · 2 Frank Parsons Show answer
Vocation Bureau, Boston, 1908; Choosing a Vocation, 1909. Know yourself, know the work, reason about the fit. Father of guidance; trait-and-factor.
Ch. 1 · 3 Clifford Beers Show answer
A Mind That Found Itself (1908). Launched the mental hygiene movement: humane treatment, prevention, early intervention.
Ch. 1 · 4 Williamson vs. Rogers Show answer
Williamson (1930s): directive, counselor-led, trait-and-factor. Rogers (1942): nondirective, then client-centered; the relationship drives change.
Ch. 1 · 5 NDEA (1958) Show answer
Passed after Sputnik; funded large-scale training of school counselors.
Ch. 1 · 6 APGA → AACD → ACA Show answer
1952 → 1983 → 1992. The association’s three names.
Ch. 1 · 7 First and last licensure states Show answer
Virginia, 1976 (first). California, 2009 (last).
Ch. 1 · 8 Culturally encapsulated counselor Show answer
Wrenn (1962): a counselor who assumes their own cultural values are universal and judges clients by them.
Ch. 1 · 9 ACA Code sections A–I Show answer
A Relationship; B Confidentiality and privacy; C Professional responsibility; D Other professionals; E Assessment; F Supervision, training, teaching; G Research; H Technology and social media; I Resolving ethical issues.
Ch. 1 · 10 The six moral principles Show answer
Autonomy, nonmaleficence, beneficence, justice, fidelity, veracity. Most ethics items pit two of them against each other.
Ch. 1 · 11 Ethics vs. law (Standard I.1.c) Show answer
Make your commitment to the Code known and try to resolve the conflict; if it cannot be resolved, you may follow the law.
Ch. 1 · 12 Values-based referral (Standard A.11.b) Show answer
Prohibited when based solely on the counselor’s personal values. Refer for competence gaps; address values through supervision and training.
Ch. 1 · 13 Impairment (Standard C.2.g) Show answer
Functioning has declined enough to affect client care. Seek help; limit, suspend, or end services until safe. Distress alone is not impairment.
Ch. 1 · 14 Colleague misconduct sequence Show answer
Informal resolution first (I.2.a) unless substantial harm or a confidentiality breach makes it inappropriate; then report (I.2.b). Consult when unsure (I.2.c).
Ch. 1 · 15 Four elements of malpractice Show answer
Duty, breach of the standard of care, harm, and causation. All four are required; intent is not.
Ch. 1 · 16 Cottone vs. Kitchener Show answer
Cottone (2001): social constructivism; decisions negotiated between people. Kitchener (1984): moral principles; intuitive and critical-evaluative levels.
Chapter 2 Confidentiality, Informed Consent, and Records
Ch. 2 · 1 Privacy vs. confidentiality vs. privilege Show answer
Privacy: the person’s right. Confidentiality: the counselor’s ethical duty. Privilege: a legal protection from disclosure in court; the client holds it and alone can waive it.
Ch. 2 · 2 Jaffee v. Redmond (1996) Show answer
U.S. Supreme Court recognized a psychotherapist–patient privilege in federal courts, including licensed social workers.
Ch. 2 · 3 Exceptions to confidentiality Show answer
Serious and foreseeable harm; suspected abuse or neglect; court order or law; client consent; communicable, life-threatening disease (permissive); team sharing with the client informed.
Ch. 2 · 4 Minimal disclosure (B.2.e) Show answer
When disclosure is required, reveal only essential information and, when possible, tell the client first and involve them.
Ch. 2 · 5 Tarasoff 1974 vs. 1976 Show answer
1974: duty to warn an identifiable victim. 1976: broadened to a duty to protect (warn, notify police, hospitalize, or other reasonable steps).
Ch. 2 · 6 Duty-to-protect checklist Show answer
Who? (identifiable victim) How bad? (serious harm) How likely? (foreseeable). Then assess, consult, take the least intrusive protective step, document.
Ch. 2 · 7 Mandatory vs. permissive states Show answer
Mandatory: must act when conditions are met. Permissive: may disclose, with good-faith protection (e.g., Texas, Thapar v. Zezulka, 1999). A few states: no duty-to-warn law.
Ch. 2 · 8 Mandated reporting Show answer
Reasonable suspicion, not proof. Don’t investigate. Report yourself; telling a supervisor is not a report. Good-faith immunity. Document.
Ch. 2 · 9 Communicable disease (B.2.c) Show answer
May disclose to an identifiable third party at serious, foreseeable risk, after assessing whether the client will tell them or keep engaging in risky behavior. Permissive, not required; follow state law.
Ch. 2 · 10 Elements of informed consent (A.2.b) Show answer
Process, risks, benefits; credentials; continuity if counselor is incapacitated; technology; diagnosis and tests; fees; confidentiality limits; records; right to refuse.
Ch. 2 · 11 Consent vs. assent Show answer
Consent: legal authorization from a competent adult or a guardian. Assent: agreement from a minor or a person who cannot legally consent. Both are sought.
Ch. 2 · 12 Four abilities of capacity Show answer
Express a choice, understand, appreciate, reason (Appelbaum & Grisso, 1988). Capacity is decision-specific; competence is a legal finding.
Ch. 2 · 13 Mandated clients (A.2.e) Show answer
Before starting: what will be shared, with whom, and the consequences of refusing services.
Ch. 2 · 14 Couples, families, groups Show answer
Couples and families: define the client and the secrets policy first (B.4.b). Groups: explain the importance and limits of confidentiality (B.4.a) and that it cannot be guaranteed.
Ch. 2 · 15 Client access to records (B.6.e) Show answer
Reasonable access for competent clients; limit only with compelling evidence of harm; document the request and rationale; offer help interpreting.
Ch. 2 · 16 Psychotherapy notes Show answer
Process notes kept separate from the record; separate authorization for most disclosures; no HIPAA right of access. Diagnosis, plan, meds, and dates do not qualify.
Ch. 2 · 17 HIPAA, HITECH, Part 2, FERPA Show answer
HIPAA: PHI floor; stricter state law wins. HITECH: breach notification, penalties. 42 CFR Part 2: substance use programs. FERPA: school records; sole-possession notes exempt.
Ch. 2 · 18 Subpoena vs. court order Show answer
Subpoena knocks: respond, contact client, consult attorney, assert privilege. Court order opens the door: seek to limit (B.2.d), then release only what is ordered.
Chapter 3 Boundaries, Supervision, Consultation, and Counselor Self-Awareness
Ch. 3 · 1 Five-year rule (Standard A.5.c) Show answer
No sexual or romantic relationship with a former client, or the client’s spouse, significant other, or family member, for 5 years after the last professional contact. Afterward, documented forethought about exploitation is still required.
Ch. 3 · 2 ACA vs. psychologists’ waiting period Show answer
ACA (counselors): 5 years since the 2005 Code (the 1995 Code said 2). American Psychological Association (psychologists): 2 years. The NCE tests the current ACA rule.
Ch. 3 · 3 Extending boundaries (Standards A.6.b–A.6.c) Show answer
Ceremony, purchase of a client’s service, hospital visit. Weigh risks and benefits, consult, document the rationale beforehand when feasible, and attempt to remedy any unintentional harm.
Ch. 3 · 4 Boundary crossing vs. violation Show answer
Crossing: a harmless or helpful departure from usual practice. Violation: a crossing that harms or exploits the client (Gutheil & Gabbard, 1993).
Ch. 3 · 5 Kitchener’s (1988) three risk factors Show answer
Harm in overlapping roles grows with incompatible expectations, divergent obligations, and a larger power and prestige difference.
Ch. 3 · 6 Gifts (Standard A.10.f) Show answer
No dollar limit. Consider the relationship, the gift’s value, the client’s motivation, and the counselor’s motivation; respect cultural meaning.
Ch. 3 · 7 Bartering (Standard A.10.e) Show answer
Client requests it; not exploitative or harmful; accepted practice among professionals in the community; clear written contract.
Ch. 3 · 8 Termination vs. abandonment Show answer
Terminate when no need, no benefit, or harm (may also for danger or nonpayment), with pretermination counseling and referrals when necessary (A.11.c). Abandonment: no notice, no referral, no coverage (A.12).
Ch. 3 · 9 Transference vs. countertransference Show answer
Transference: client’s past-relationship feelings directed at the counselor. Countertransference: counselor’s reactions rooted in the counselor’s own history.
Ch. 3 · 10 Burnout vs. compassion fatigue vs. vicarious trauma Show answer
Burnout: job exhaustion, depersonalization, low accomplishment (Maslach). Compassion fatigue: secondary traumatic stress (Figley). Vicarious trauma: changed beliefs about self, others, and the world (McCann & Pearlman).
Ch. 3 · 11 IDM levels (Stoltenberg) Show answer
Level 1: anxious, motivated, dependent, self-focused. Level 2: wavering, dependence vs. autonomy, client-focused. Level 3: stable, autonomous. 3i: integrated across areas.
Ch. 3 · 12 Bernard’s discrimination model Show answer
Roles: teacher, counselor, consultant. Foci: intervention, conceptualization, personalization. Nine combinations.
Ch. 3 · 13 Supervisor duties (Section F) Show answer
Monitor client welfare (F.1.a); supervisees disclose status (F.5.c); trained supervisors (F.2.a); no counseling of supervisees (F.6.c); gatekeeping and remediation (F.6.b).
Ch. 3 · 14 Caplan’s four types Show answer
Client-centered case; consultee-centered case (theme interference); program-centered administrative; consultee-centered administrative.
Ch. 3 · 15 Schein’s three models Show answer
Purchase of expertise (buy a solution); doctor–patient (consultant diagnoses and prescribes); process consultation (consultee learns to solve its own problems).
Ch. 3 · 16 Consultation vs. supervision vs. collaboration Show answer
Consultation: voluntary, nonevaluative, consultee keeps responsibility. Supervision: evaluative, hierarchical, ongoing. Collaboration: shared responsibility.
Chapter 4 Practice Management: Documentation, Billing, Telemental Health, and Technology
Ch. 4 · 1 SOAP note Show answer
Subjective (what the client reports) · Objective (what the counselor observes or scores) · Assessment (clinical impression) · Plan (next steps).
Ch. 4 · 2 DAP vs. BIRP vs. GIRP Show answer
DAP: Data, Assessment, Plan. BIRP: Behavior, Intervention, Response, Plan. GIRP: Goal, Intervention, Response, Plan.
Ch. 4 · 3 S or O? Show answer
If the client said it, it is subjective, even a symptom. If the counselor saw, heard, or scored it, it is objective.
Ch. 4 · 4 Late entry Show answer
Written now, dated now, labeled as referring to the earlier session. Never backdate or rewrite a note.
Ch. 4 · 5 Medical necessity Show answer
Covered diagnosis + impaired functioning + appropriate treatment and level of care + documented progress. Notes must support every claim (6.10).
Ch. 4 · 6 NPI, CPT, ICD-10-CM Show answer
NPI = who provided the service (10 digits). CPT = what service. ICD-10-CM = why it was needed.
Ch. 4 · 7 CAQH Show answer
Credentialing database many insurers check before paneling a counselor (renamed DataSpring in 2026; its profile tool, ProView, was renamed the Provider Data Portal in 2023). Keep it current and re-attest every 120 days (180 in Illinois).
Ch. 4 · 8 Billing fraud patterns Show answer
Upcoding · billing missed sessions · false or inflated diagnosis · billing under another clinician’s NPI · routinely waiving copays without telling the insurer (hardship waivers are case by case).
Ch. 4 · 9 Telemental health consent (H.2.a) Show answer
Credentials and location · confidentiality limits online · technology failure and backup contact · response time · emergency procedures · time-zone and cultural differences · insurance limits · social media policy.
Ch. 4 · 10 The location rule Show answer
Authority to practice depends on where the client is located during the session. Confirm location at the start of every session.
Ch. 4 · 11 Dropped session with a client at risk Show answer
Follow the agreed backup plan (call the phone on file) → complete the risk assessment → if unreachable, emergency contact and local resources → document.
Ch. 4 · 12 AI in practice (1A.7, 6.19) Show answer
Competence · disclose and get consent (B.6.c for recording) · BAA and no client data in public tools · review every AI-drafted note · human makes clinical decisions.
Ch. 4 · 13 Three plans Show answer
Emergency preparedness = the practice (6.1 follow, 6.15 update). Disruption of service = each client (3B.6). Professional will = counselor’s death or incapacity (C.2.h).
Ch. 4 · 14 ADA in a private practice Show answer
Title III public accommodation: reasonable modifications and effective communication (e.g., ASL interpreter) at no charge to the client.
Ch. 4 · 15 Interpreter vs. translator Show answer
Interpreter: spoken or signed language in real time. Translator: written documents. Use qualified professionals, never the client’s child (A.2.c; Task 5.7).
Ch. 4 · 16 Counseling Compact Show answer
Full home-state license → privilege to practice in member states → follow the remote state’s laws. Home license encumbered = privileges lost until it clears and two years pass without a new encumbrance. Nonmember states not covered.
Ch. 4 · 17 Ethical marketing (6.20) Show answer
Truthful ads (C.3.a); no solicited testimonials from clients (C.3.b); separate personal and professional online presence (H.6.a); never confirm a client relationship when replying to reviews.
Chapter 5 The Intake, Risk Assessment, and Mental Status
Ch. 5 · 1 Order of a first session Show answer
Consent and confidentiality limits → presenting problem (why now) → risk screen → history, observing mental status → barriers, shared summary, next steps. Acute crisis: safety first.
Ch. 5 · 2 Structured vs. semi-structured vs. unstructured interview Show answer
Fixed questions in fixed order / set topics in flexible order (most agency intakes) / follows the client.
Ch. 5 · 3 Collateral information (2027 task 2A.4) Show answer
Information from family, prior providers, schools, clergy, or legal services. Requires a written release first.
Ch. 5 · 4 Biopsychosocial domains Show answer
Biological: health, medications, sleep, substances. Psychological: problem history, prior treatment, trauma, coping, strengths. Social: family, work, housing, culture, supports.
Ch. 5 · 5 The four Ps Show answer
Predisposing (why this person), precipitating (why now), perpetuating (why still), protective (what helps).
Ch. 5 · 6 Genogram Show answer
At least three generations: structure, relationships (closeness, conflict, cutoff), and recurring patterns such as substance use or suicide.
Ch. 5 · 7 Screening vs. assessment Show answer
Screen: brief, universal, sensitive; asks “look closer?” Assessment: longer, targeted, describes nature and severity. Positive screen → assessment, not diagnosis.
Ch. 5 · 8 Suicide inquiry checklist Show answer
Ideation (passive or active), plan, means and access, intent, timeline, preparation, prior attempts, self-injury. Ask directly; asking does not plant the idea.
Ch. 5 · 9 Risk factors vs. warning signs Show answer
Risk factors raise risk over time (static or dynamic). Warning signs signal near-term danger (talk of dying or being a burden, seeking a method, saying goodbye).
Ch. 5 · 10 C-SSRS vs. ASQ Show answer
C-SSRS: Columbia scale for ideation and behavior; screener needs no mental health training. ASQ: four yes/no questions for medical settings; any yes → “thoughts of suicide right now?”
Ch. 5 · 11 Safety Planning Intervention (Stanley & Brown) Show answer
1 warning signs · 2 internal coping · 3 distracting people and places · 4 people to ask for help · 5 professionals and crisis lines (988) · 6 making the environment safe.
Ch. 5 · 12 Lethal means counseling Show answer
A collaborative conversation that puts time and distance between the person and the method (relative holds a firearm; medications locked). Not a confiscation.
Ch. 5 · 13 No-suicide contract Show answer
Never the best answer: no evidence of effectiveness, and never a substitute for risk assessment. Replace with a collaborative safety plan.
Ch. 5 · 14 Trauma screening at intake Show answer
Event, experience, effects (SAMHSA). Screen exposure and current effects; let the client control detail; don’t press for the full story.
Ch. 5 · 15 ACE score Show answer
Counts categories of childhood abuse, neglect, and household challenges (10 in the familiar version). Graded link to adult health risk; flags risk, does not diagnose.
Ch. 5 · 16 Substance screens Show answer
AUDIT: 10 items, 8 or more. CAGE: 4 items, 2 or more. DAST-10: drugs other than alcohol. CRAFFT: ages 12 to 21, 2 or more. SBIRT: screen, brief intervention, referral.
Ch. 5 · 17 MSE confusable pairs Show answer
Mood (said) vs. affect (seen). Circumstantial (arrives) vs. tangential (never returns). Hallucination (no stimulus) vs. illusion (real stimulus misread) vs. delusion (false belief). Insight (understanding) vs. judgment (decisions).
Chapter 6 Diagnosis: DSM-5-TR and ICD
Ch. 6 · 1 DSM-III (1980) Show answer
Introduced explicit diagnostic criteria, the multiaxial system, and a stance neutral about causes.
Ch. 6 · 2 DSM-5 (2013) Show answer
Dropped the five axes; stressors noted with Z codes; GAF dropped (WHODAS 2.0 offered); “not otherwise specified” replaced by other specified and unspecified.
Ch. 6 · 3 DSM-5-TR (2022) Show answer
Text revision: updated text and codes; added prolonged grief disorder and unspecified mood disorder; codes for suicidal behavior and nonsuicidal self-injury; review for racism and stigmatizing language.
Ch. 6 · 4 Mental disorder (DSM) Show answer
Clinically significant disturbance in thinking, emotion regulation, or behavior reflecting a dysfunction, usually with distress or impairment. Expectable responses to loss are not disorders.
Ch. 6 · 5 Subtype vs. specifier vs. provisional Show answer
Subtype: mutually exclusive, choose one. Specifier: course, features, severity; combine freely. Provisional: full criteria expected once more information arrives.
Ch. 6 · 6 Other specified vs. unspecified Show answer
Other specified shows its work: the reason criteria are not met is recorded. Unspecified leaves it blank, often for lack of information (emergency department).
Ch. 6 · 7 Recording a diagnosis Show answer
ICD-10-CM code, then the DSM name and specifiers. Principal diagnosis (inpatient) or reason for visit (outpatient) first. Example: F10.20 is written “alcohol use disorder, moderate.”
Ch. 6 · 8 ICD-10-CM Show answer
U.S. clinical modification of ICD-10; required diagnosis code set on claims since October 1, 2015; most DSM disorders are F codes. The DSM prints these codes; it has none of its own.
Ch. 6 · 9 ICD-11 Show answer
WHO; in effect January 1, 2022; not yet on U.S. claims. Diagnostic requirements instead of strict counts; complex PTSD, prolonged grief, gaming disorder; dimensional personality disorder; gender incongruence moved to a sexual health chapter.
Ch. 6 · 10 Z codes Show answer
Conditions that may be a focus of clinical attention but are not mental disorders: relational, abuse, educational, occupational, housing, economic problems; acculturation difficulty; uncomplicated bereavement. Alone or beside a diagnosis.
Ch. 6 · 11 Cultural Formulation Interview Show answer
16 questions, 4 domains: What is it? Why is it happening? How have you coped? What would help now? Informant version and supplementary modules. Never the sole basis for a diagnosis.
Ch. 6 · 12 Cultural concepts of distress Show answer
Syndromes (ataque de nervios, taijin kyofusho), idioms of distress (nervios), and cultural explanations (susto).
Ch. 6 · 13 Six-step differential (First, 2014) Show answer
Rule out malingering and factitious disorder → substance → medical condition; then name the primary disorder → adjustment vs. residual categories → no disorder at all.
Ch. 6 · 14 Medical red flags Show answer
Sudden onset, prominent physical symptoms, first episode late in life, a medication change. Refer for a medical evaluation before settling on a diagnosis (e.g., thyroid disease).
Ch. 6 · 15 Comorbidity rules Show answer
Allowed when criteria for each are met. Mania or hypomania ever → not MDD. DMDD + ODD → DMDD only. Autism + ADHD → both allowed (not in DSM-IV).
Ch. 6 · 16 Ethics of diagnosis Show answer
E.5.a proper diagnosis; E.5.b culture; E.5.c historical prejudice; E.5.d may refrain; C.6.b honest reports (no up- or down-coding); A.2.b and 2027 task 3A.7: review the diagnosis with the client.
Chapter 7 Measurement Foundations
Ch. 7 · 1 Four scales of measurement Show answer
Nominal (categories; mode) · ordinal (rank order; median, percentiles) · interval (equal units, no true zero; mean, SD; IQ, T-scores) · ratio (true zero; “twice as much”). Stevens (1946).
Ch. 7 · 2 Norm- vs. criterion-referenced vs. ipsative Show answer
Norm-referenced: compared with a group. Criterion-referenced: compared with a fixed standard (the NCE). Ipsative: compared with the person’s own profile.
Ch. 7 · 3 A good norm group Show answer
Recent, representative, and relevant to the client. Instruments normed on other populations are used with caution (Standard E.8).
Ch. 7 · 4 Normal curve areas Show answer
About 34, 14, and 2 percent per side between successive SDs; about 68, 95, and 99.7 percent within 1, 2, and 3 SD.
Ch. 7 · 5 Percentile anchors Show answer
−2 SD ≈ 2nd · −1 SD ≈ 16th · mean = 50th · +1 SD ≈ 84th · +2 SD ≈ 98th. Percentile ranks are ordinal and are not percent correct.
Ch. 7 · 6 Standard score systems Show answer
z (mean 0, SD 1) · T (50, 10) · deviation IQ (100, 15) · stanine (5, about 2). Any score = its mean + (z × its SD).
Ch. 7 · 7 Stanines Show answer
Nine bands; each band except 1 and 9 is half an SD wide; stanine 5 holds the middle 20 percent.
Ch. 7 · 8 Reliability coefficient Show answer
Proportion of observed-score variance that is true-score variance (.85 = 85 percent). Not squared.
Ch. 7 · 9 Four kinds of reliability Show answer
Test-retest (stability over time) · alternate forms (equivalence) · internal consistency (one administration) · inter-rater (agreement among scorers).
Ch. 7 · 10 Internal-consistency statistics Show answer
Split-half, corrected upward with Spearman-Brown · KR-20 for right/wrong items · coefficient alpha for rating-scale items. Avoid split-half on speeded tests.
Ch. 7 · 11 Cohen’s kappa Show answer
Agreement between two raters on categories, corrected for chance agreement (Cohen, 1960).
Ch. 7 · 12 Standard error of measurement Show answer
SEM = SD × √(1 − reliability). Score ±1 SEM ≈ 68 percent band; ±2 SEM (1.96) ≈ 95 percent band. Higher reliability, smaller SEM.
Ch. 7 · 13 Three standard errors Show answer
SEM: one person’s score (reliability). Standard error of the mean: sample means (research). Standard error of estimate: error predicting a criterion (validity).
Ch. 7 · 14 Measuring change (2T) Show answer
Reliable change index: change ÷ standard error of the difference; beyond ±1.96 is unlikely to be error alone (Jacobson & Truax, 1991). Extreme scorers regress toward the mean on retest.
Ch. 7 · 15 Validity evidence Show answer
Content (expert review vs. blueprint) · criterion-related: concurrent (now) or predictive (later) · construct: convergent and discriminant. Face validity is not technical evidence.
Ch. 7 · 16 Reliability and validity Show answer
Reliability is necessary but not sufficient. Validity coefficient ≤ √reliability (reliability .64 → validity at most .80). Square a validity coefficient for shared variance.
Ch. 7 · 17 Sensitivity vs. specificity Show answer
Sensitivity: share of true cases the screener flags. Specificity: share of non-cases it clears. When high scores signal the condition, lowering the cut score raises sensitivity and lowers specificity.
Ch. 7 · 18 Item analysis Show answer
Difficulty p = proportion correct (higher = easier; near .50 spreads scores best). Discrimination D = upper-group minus lower-group proportion; negative = miskeyed or ambiguous.
Chapter 8 Tests and Instruments
Ch. 8 · 1 Ability vs. personality measures Show answer
Ability: “do your best” (maximal performance): intelligence, aptitude, achievement. Personality and interests: “how you usually are” (typical performance).
Ch. 8 · 2 Aptitude vs. achievement Show answer
Aptitude predicts future performance (SAT, GRE, ASVAB). Achievement measures what has been learned (WIAT, WRAT). Purpose, not content, separates them.
Ch. 8 · 3 Speed vs. power test Show answer
Speed: many easy items, strict time limit. Power: items of rising difficulty, ample time.
Ch. 8 · 4 Intelligence theorists Show answer
Spearman: g. Thurstone: primary mental abilities. Cattell and Horn: fluid vs. crystallized. Gardner: multiple intelligences. Sternberg: analytical, creative, practical.
Ch. 8 · 5 Ratio IQ vs. deviation IQ Show answer
Ratio: mental age ÷ chronological age × 100 (Terman’s Stanford-Binet, 1916). Deviation: comparison with same-age peers, mean 100, SD 15 (Wechsler).
Ch. 8 · 6 Wechsler scales by age Show answer
WPPSI: about 2½ to 7½. WISC: 6 to 16. WAIS: 16 to 90. Full Scale IQ plus index scores.
Ch. 8 · 7 Intellectual disability: two kinds of evidence Show answer
Intellectual deficits (IQ about 2 SD below the mean, roughly 65–75) plus adaptive deficits (e.g., Vineland), both beginning in the developmental period. Severity follows adaptive functioning.
Ch. 8 · 8 Objective vs. projective Show answer
Objective: fixed answers scored the same way (MMPI-3, NEO PI-3, MBTI). Projective: ambiguous stimuli, open responses (Rorschach, TAT, sentence completion, drawings).
Ch. 8 · 9 MMPI-3 Show answer
335 true/false items, adults 18+, T scores (2020). Validity scales first: inconsistency (VRIN, TRIN, CRIN), overreporting (F family), underreporting (L, K).
Ch. 8 · 10 Empirical criterion keying Show answer
Items kept because they separated clinical groups, regardless of content. The method behind the original MMPI (Hathaway and McKinley, 1943).
Ch. 8 · 11 MBTI vs. NEO PI-3 Show answer
MBTI: Jungian types, four preference pairs, 16 types; preferences, not ability or pathology. NEO PI-3: Big Five domains plus 30 facets.
Ch. 8 · 12 Rorschach and TAT Show answer
Rorschach (1921): 10 inkblots. TAT (Morgan and Murray, 1935): stories about picture cards. Both projective; need extensive training.
Ch. 8 · 13 Symptom measures at a glance Show answer
PHQ-9 (0–27), GAD-7 (0–21), BDI-II (0–63): past 2 weeks. BAI (0–63): mostly physical anxiety symptoms, past week. PCL-5 (0–80): past month. Ceiling = items × top rating.
Ch. 8 · 14 PHQ-9 item 9 Show answer
Any endorsement of thoughts of death or self-harm calls for a same-day suicide risk assessment, whatever the total score.
Ch. 8 · 15 Formal vs. informal observation Show answer
Formal has a form: rating scales, recording methods, structured interviews, MSE. Informal: body language, affect, waiting-room behavior; generates hypotheses.
Ch. 8 · 16 ACA Section E essentials Show answer
Competent with that instrument (E.2.a); responsible for software interpretations (E.2.b); explain before testing (E.3.a); release identified data only with consent, to qualified persons, with interpretation (E.3.b, E.4); report with the client’s background in mind (E.9.a).
Chapter 9 Research, Statistics, and Program Evaluation
Ch. 9 · 1 Random assignment vs. random selection Show answer
Assignment (to conditions by chance) earns cause. Selection (from a population by chance) earns generalization. A study can have one without the other.
Ch. 9 · 2 What each design can conclude Show answer
True experiment (manipulated IV + random assignment): cause. Quasi-experiment (intact groups): cause, tentatively. Ex post facto: group differences. Correlational: relationship and prediction.
Ch. 9 · 3 Other designs to know Show answer
Solomon four-group (Solomon, 1949): shows whether the pretest changed results. Factorial: two or more IVs; detects interactions. Single-case: A = baseline, B = treatment; ABAB reversal; multiple baseline.
Ch. 9 · 4 Threats to internal validity (Campbell & Stanley, 1963) Show answer
History, maturation, testing, instrumentation, statistical regression, selection, mortality (attrition), and their interactions. Each could explain change without the treatment.
Ch. 9 · 5 More threats and effects Show answer
Diffusion of treatment, compensatory rivalry (John Henry), resentful demoralization (Cook & Campbell, 1979). Hawthorne: change from being studied. Placebo: change from expectation. Blinding controls placebo and expectancy effects.
Ch. 9 · 6 Central tendency and skew Show answer
Skewed data: median. Mean follows the tail; the tail names the skew. Positive skew: tail right, mean highest. Negative skew: tail left, mean lowest.
Ch. 9 · 7 Correlation Show answer
−1.00 to +1.00. Sign = direction; absolute value = strength (−.72 beats +.58). r squared = shared variance (.70 → 49 percent). Not causation.
Ch. 9 · 8 p-value and alpha Show answer
Alpha (.05 or .01) is set first. p is the probability of results at least this extreme if the null is true. p < alpha: reject the null (statistically significant).
Ch. 9 · 9 Type I vs. Type II error Show answer
Type I: reject a true null; false positive; probability alpha. Type II: fail to reject a false null; missed effect; probability beta. Lower alpha → fewer Type I, more Type II.
Ch. 9 · 10 Power Show answer
1 − beta; the chance of detecting a real effect. Rises with larger samples, larger effects, higher alpha, one-tailed tests, less error. Target .80 (Cohen, 1992).
Ch. 9 · 11 Effect size and clinical significance Show answer
Significance is not size. Cohen’s d: .20 small, .50 medium, .80 large. Clinical significance: reliable change plus ending in the nonclinical range (Jacobson & Truax, 1991).
Ch. 9 · 12 Which statistical test? Show answer
Counts in categories: chi-square. Two means: t (independent or paired). Three or more: ANOVA. Two IVs: factorial ANOVA. Relationship: Pearson or Spearman. Prediction: regression.
Ch. 9 · 13 Qualitative traditions Show answer
Phenomenology: lived experience, bracketing. Grounded theory: theory from data, constant comparison. Ethnography: culture, participant observation. Case study: one bounded case.
Ch. 9 · 14 Trustworthiness (Lincoln & Guba, 1985) Show answer
Credibility, transferability, dependability, confirmability. Built through triangulation, member checking, thick description, prolonged engagement, and an audit trail.
Ch. 9 · 15 Program evaluation sequence Show answer
Needs assessment → logic model (inputs, activities, outputs, outcomes) → formative evaluation (during, improve) → summative evaluation (end, keep or cut). Scriven (1967) named formative vs. summative.
Ch. 9 · 16 Research ethics Show answer
Belmont: respect for persons, beneficence, justice. IRB review. ACA Section G: consent, withdraw without penalty, clients free to decline, debrief, report unfavorable results, student as lead author.
Chapter 10 Depressive, Bipolar, and Related Disorders
Ch. 10 · 1 Major depressive episode Show answer
Five of nine symptoms in the same 2 weeks, most nearly every day; one must be depressed mood or loss of interest or pleasure. Youth: mood may be irritable. MDD also requires that mania or hypomania never occurred.
Ch. 10 · 2 The nine symptoms Show answer
Depressed mood · anhedonia · appetite or weight change · insomnia or hypersomnia · agitation or slowing · fatigue · worthlessness or guilt · poor concentration · thoughts of death or suicide.
Ch. 10 · 3 Grief vs. depression Show answer
Grief: waves tied to reminders, positive emotion possible, self-esteem intact. Depression: pervasive low mood, little anticipated pleasure, worthlessness. DSM-5 removed the bereavement exclusion.
Ch. 10 · 4 Persistent depressive disorder Show answer
Depressed mood more days than not for 2 years (1 in youth) plus two of six symptoms; never symptom-free over 2 months. Merged dysthymia and chronic major depression.
Ch. 10 · 5 Double depression (DSM-5-TR) Show answer
A full major depressive episode during PDD. DSM-5-TR clarified that MDD is diagnosed in addition to PDD.
Ch. 10 · 6 PMDD Show answer
Five or more symptoms in the week before menses, easing after onset and minimal the week after; confirmed by prospective daily ratings over at least two cycles.
Ch. 10 · 7 DMDD Show answer
Severe outbursts about three or more times a week plus irritability between them; 12 months; two or more settings; first diagnosed at 6 to 18; onset before 10. Overrides ODD; any mania or hypomania rules it out.
Ch. 10 · 8 Manic episode Show answer
Elevated, expansive, or irritable mood plus increased energy; at least 1 week (any length if hospitalized); three of seven symptoms (four if only irritable); marked impairment, hospitalization, or psychosis.
Ch. 10 · 9 Hypomanic episode Show answer
Same symptoms for at least 4 consecutive days; a change others can see; no marked impairment, hospitalization, or psychosis.
Ch. 10 · 10 Bipolar I vs. II vs. cyclothymic Show answer
I: one manic episode (depression not required). II: hypomanic + major depressive episode, never mania; not a milder bipolar I. Cyclothymic: 2 years (1 in youth) of subthreshold highs and lows.
Ch. 10 · 11 The 4–7–14 ladder Show answer
Hypomania 4 days · mania 7 days · major depressive episode 14 days. PDD and cyclothymic disorder: 2 years in adults, 1 in youth.
Ch. 10 · 12 Specifiers Show answer
Anxious distress · mixed features · melancholic · atypical · psychotic features · catatonia · peripartum onset (pregnancy or 4 weeks after delivery) · seasonal pattern · rapid cycling (4+ episodes in 12 months; bipolar I and II only).
Ch. 10 · 13 Antidepressant-emergent mania Show answer
Mania that starts during antidepressant treatment and persists at full strength beyond the drug’s effect counts as mania: bipolar I. Screen for past highs before any depression plan (2027 task 3A.8).
Ch. 10 · 14 Rule-outs Show answer
Substances and medical causes (thyroid) first · adjustment disorder (within 3 months of a stressor) · schizoaffective disorder (2 weeks of psychosis without a mood episode) · chronic irritability → DMDD, not bipolar.
Ch. 10 · 15 Hopelessness Show answer
Beck’s cognitive triad: self, world, future. Hopelessness theory: stable (“always”) and global (“everything”) explanations (Abramson et al., 1989). Hopelessness predicted eventual suicide (Beck et al., 1985) → assess risk.
Ch. 10 · 16 Loneliness Show answer
Subjective, distressing gap between wanted and actual connection; social isolation is objective. Interventions targeting maladaptive social cognition (expecting rejection) did best (Masi et al., 2011).
Ch. 10 · 17 Depression treatment Show answer
Adults: psychotherapy (behavioral, CBT, MBCT, IPT, psychodynamic, supportive) or a second-generation antidepressant; combined: CBT or IPT + antidepressant. Teens: CBT or IPT-A. IPT’s four areas: grief, role disputes, role transitions, interpersonal deficits. MBCT: relapse prevention in remission.
Ch. 10 · 18 Bipolar treatment Show answer
Prescriber’s medication (mood stabilizers such as lithium) is the foundation; add psychoeducation (family or group formats), CBT, family, or interpersonal work. Counselor: warning signs (less sleep), regular routines, family involvement with consent, ongoing risk assessment.
Chapter 11 Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders
Ch. 11 · 1 Anxiety durations Show answer
Typically 6 months: specific phobia, social anxiety, agoraphobia, adult separation anxiety; at least 6 months: GAD. One month: panic disorder (after an attack), selective mutism, separation anxiety in youth (4 weeks).
Ch. 11 · 2 Generalized anxiety disorder Show answer
Hard-to-control worry about many matters, more days than not, for at least 6 months, plus three of six symptoms (one in children): restless, tired, unfocused, irritable, tense, poor sleep.
Ch. 11 · 3 Panic attack vs. panic disorder vs. agoraphobia Show answer
Attack: fear peaking within minutes, 4 of 13 symptoms; a specifier. Disorder: unexpected attacks plus 1 month of worry or avoidance. Agoraphobia: 2 of 5 situations; diagnosed separately.
Ch. 11 · 4 Phobia and social anxiety specifiers Show answer
Specific phobia: animal, natural environment, blood-injection-injury, situational, other. Social anxiety: “performance only”; in children, fear must occur with peers, not only adults.
Ch. 11 · 5 OCD essentials Show answer
Obsessions (intrusive, unwanted) and/or compulsions (rituals to neutralize distress); time-consuming (e.g., over 1 hour a day), distressing, or impairing; no minimum duration. Insight: good/fair, poor, absent/delusional.
Ch. 11 · 6 OCD-related disorders Show answer
Body dysmorphic disorder (perceived flaw; mirror checking), hoarding disorder (difficulty discarding), trichotillomania (hair pulling), excoriation disorder (skin picking).
Ch. 11 · 7 Obsession vs. OCPD vs. GAD worry Show answer
Obsession: an unwanted intruder that drives rituals. OCPD: perfectionism and control the person endorses, no true obsessions or rituals. GAD: worry about real-life matters.
Ch. 11 · 8 PTSD Criterion A Show answer
Actual or threatened death, serious injury, or sexual violence: experienced, witnessed in person, learned about for a loved one (death violent or accidental), or repeated exposure to details at work. Media counts only through work.
Ch. 11 · 9 PTSD clusters and specifiers Show answer
Intrusion, avoidance, negative changes in thinking and mood, arousal and reactivity; more than 1 month. Specifiers: with dissociative symptoms; with delayed expression (full criteria at 6 months or later).
Ch. 11 · 10 Trauma timeline Show answer
Acute stress disorder: 3 days to 1 month, nine of 14 symptoms. PTSD: more than 1 month. Adjustment disorder: any stressor, onset within 3 months, resolves within 6 months after it or its consequences end.
Ch. 11 · 11 Reactive attachment vs. disinhibited social engagement Show answer
Both follow severe early neglect. Reactive attachment: withdrawn, rarely seeks comfort. Disinhibited social engagement: approaches strangers and may wander off with them.
Ch. 11 · 12 Complex PTSD (ICD-11) Show answer
Core PTSD symptoms plus severe emotion dysregulation, a worthless or ashamed self-view, and relationship difficulties, usually after prolonged or repeated trauma. Not a DSM-5-TR diagnosis.
Ch. 11 · 13 Sorting somatic presentations Show answer
Faked for an external reward: malingering (not a disorder). Faked, no reward: factitious disorder. Real symptoms plus excessive worry: somatic symptom disorder. Little symptom, big worry: illness anxiety disorder. Neurological mismatch: functional neurological symptom disorder.
Ch. 11 · 14 Dissociative disorders Show answer
Dissociative identity disorder: two or more personality states, memory gaps. Dissociative amnesia: lost personal memories, fugue as a specifier. Depersonalization/derealization: detachment with reality testing intact.
Ch. 11 · 15 Exposure toolkit Show answer
Systematic desensitization (Wolpe): relaxation plus a graded hierarchy. Flooding: start at the top. Interoceptive: body sensations, for panic. ERP: trigger without ritual, for OCD. Habit reversal: hair pulling and skin picking.
Ch. 11 · 16 Trauma-focused therapies Show answer
PE (Foa): imaginal and in vivo exposure. CPT (Resick): challenging stuck points. EMDR (Shapiro): memory plus bilateral stimulation. TF-CBT (Cohen, Mannarino, Deblinger): ages 3–18 with a caregiver.
Ch. 11 · 17 Contraindications (2027 task 3A.8) Show answer
Safety before trauma processing. No single-session debriefing for everyone. No benzodiazepines for PTSD. No reassurance for OCD. Applied tension, not relaxation, for blood-injection-injury phobia.
Chapter 12 Substance Use and Addictive Disorders
Ch. 12 · 1 Substance use disorder severity Show answer
At least 2 of 11 criteria in 12 months. Mild 2–3, moderate 4–5, severe 6 or more. Severity starts on the even numbers.
Ch. 12 · 2 What DSM-5 changed Show answer
Merged abuse and dependence into one substance use disorder, added craving, dropped legal problems, and moved gambling into the chapter.
Ch. 12 · 3 Prescribed-medication exclusion Show answer
Tolerance and withdrawal do not count when a medication is taken as prescribed under medical supervision. Physical dependence is not addiction.
Ch. 12 · 4 Early vs. sustained remission Show answer
Early: 3 to under 12 months with no criteria except craving. Sustained: 12 months or longer. Specifiers: in a controlled environment; on maintenance therapy (opioids, tobacco).
Ch. 12 · 5 Which withdrawal can kill? Show answer
Alcohol and sedatives (benzodiazepines, barbiturates): seizures and delirium; medically managed. Opioids: miserable but rarely fatal; the danger is overdose, reversed by naloxone. Stimulants: crash, depressed mood.
Ch. 12 · 6 Substance-induced vs. independent disorder Show answer
Symptoms that began before use, or persist about 1 month after withdrawal or intoxication ends, suggest an independent disorder.
Ch. 12 · 7 Gambling disorder Show answer
Only non-substance addictive disorder. At least 4 of 9 criteria in 12 months (mild 4–5, moderate 6–7, severe 8–9). Chasing losses. Rule out mania. Internet gaming disorder: Section III.
Ch. 12 · 8 Models of addiction Show answer
Moral (failure of will; discredited). Disease (Jellinek, 1960; abstinence). Behavioral (learned habit). Biopsychosocial (today’s consensus). Public health (reduce harm).
Ch. 12 · 9 Harm reduction Show answer
Reduce the damage of use that continues: naloxone, syringe services, medications. Like abstinence, a legitimate goal chosen with the client.
Ch. 12 · 10 Stages of change and the counselor’s job Show answer
Precontemplation: a reason. Contemplation: a tipping point. Preparation: a plan. Action: skills. Maintenance: a guard. Relapse means recycling, not starting over.
Ch. 12 · 11 Motivational interviewing Show answer
Miller (1983). Evoke change talk; respond to sustain talk without arguing; OARS (open questions, affirmations, reflections, summaries). Confrontational counseling is contraindicated: more confrontation, more drinking (Miller et al., 1993).
Ch. 12 · 12 ASAM Criteria Show answer
Six dimensions (third edition): withdrawal, biomedical, emotional/behavioral, readiness, relapse potential, recovery environment. Levels 0.5 to 4. Choose the least intensive safe level.
Ch. 12 · 13 MOUD Show answer
Methadone: full agonist, certified opioid treatment programs. Buprenorphine: partial agonist, ceiling effect, office-based. Naltrexone: antagonist; start only when opioid-free.
Ch. 12 · 14 Medications for alcohol use disorder Show answer
Disulfiram (drinking causes flushing and nausea), naltrexone (reduces reward and craving), acamprosate (eases early abstinence).
Ch. 12 · 15 Relapse prevention Show answer
Marlatt and Gordon (1985). High-risk situations and coping. Lapse is a slip; relapse is a return to the pattern. Abstinence violation effect: “I’ve blown it.”
Ch. 12 · 16 Contingency management, mutual help, co-occurring care Show answer
Contingency management: rewards for verified abstinence; strong for stimulants. AA, NA (twelve steps), SMART Recovery (secular), Al-Anon (families). Co-occurring disorders: integrated, not sequential or parallel.
Chapter 13 Other Diagnostic Groups
Ch. 13 · 1 ADHD rules Show answer
Six symptoms of inattention and/or hyperactivity-impulsivity (five from age 17) for 6 months; several before age 12; several in two or more settings. Presentations: combined, predominantly inattentive, predominantly hyperactive/impulsive.
Ch. 13 · 2 ADHD treatment by age Show answer
Under 6: behavioral parent training first. Age 6 and older: medication and behavior therapy together, plus classroom supports (CDC, 2026).
Ch. 13 · 3 Executive functions Show answer
Inhibitory control, working memory, cognitive flexibility (Diamond, 2013). Not a diagnosis. Externalize them: planners, timers, checklists, tasks broken into steps.
Ch. 13 · 4 Autism vs. social (pragmatic) communication disorder Show answer
Both: social communication deficits. Only autism: restricted, repetitive behaviors (two of four). Autism is rated Level 1, 2, or 3 per domain by support needed.
Ch. 13 · 5 Intellectual and learning disorders Show answer
Intellectual developmental disorder: intellectual + adaptive deficits, developmental onset; severity by adaptive functioning. Specific learning disorder: persists 6 months despite targeted help; no IQ-achievement discrepancy required.
Ch. 13 · 6 Psychosis by duration Show answer
Brief psychotic disorder: 1 day to under 1 month. Schizophreniform: 1 to under 6 months. Schizophrenia: 6 months (1 month active). Delusional disorder: delusions for 1 month or more.
Ch. 13 · 7 Schizoaffective vs. mood disorder with psychotic features Show answer
Psychosis for 2 weeks or more without a mood episode, with mood episodes for most of the illness: schizoaffective. Psychosis only during mood episodes: mood disorder with psychotic features.
Ch. 13 · 8 Responding to a delusion Show answer
Neither argue nor agree. Acknowledge the distress, say you do not share the experience, assess safety (command hallucinations), arrange a psychiatric evaluation.
Ch. 13 · 9 Personality clusters Show answer
A keeps apart: paranoid, schizoid, schizotypal. B starts a blaze: antisocial, borderline, histrionic, narcissistic. C stays careful: avoidant, dependent, obsessive-compulsive.
Ch. 13 · 10 Commonly confused personality pairs Show answer
Schizoid: does not want relationships. Avoidant: wants them, fears rejection. OCPD: perfectionism seen as reasonable. OCD: unwanted obsessions and compulsions. Antisocial: age 18+, conduct disorder before 15.
Ch. 13 · 11 Dialectical behavior therapy (DBT) Show answer
Most researched treatment for borderline personality disorder (Storebø et al., 2020); developed by Linehan (1993). Individual therapy, skills groups (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness), phone coaching, consultation team.
Ch. 13 · 12 Eating disorders: weight decides Show answer
Anorexia: significantly low weight (purging makes it binge-eating/purging type). Bulimia: typical or above. Binge-eating disorder: no compensation. ARFID: no body-image concern. Young people with anorexia: family therapy; adults with bulimia or binge eating: CBT (NICE, 2020).
Ch. 13 · 13 Insomnia and CBT-I Show answer
Insomnia disorder: 3 nights a week for 3 months. CBT-I first: stimulus control, sleep restriction, cognitive work, relaxation. Sleep hygiene alone is not recommended (Edinger et al., 2021).
Ch. 13 · 14 Delirium vs. neurocognitive disorder Show answer
Delirium: hours to days, fluctuating attention, medical cause, emergency. Major neurocognitive disorder: independence lost. Mild: independence kept with effort. MMSE screens (Folstein et al., 1975).
Ch. 13 · 15 ODD vs. conduct disorder Show answer
ODD: four symptoms of anger, defiance, or vindictiveness for 6 months. Conduct disorder: 3 of 15 in 12 months, violating rights; childhood-onset (before 10) is worse. IED: from age 6.
Ch. 13 · 16 Elimination disorders Show answer
Enuresis: age 5, twice a week for 3 months. Encopresis: age 4, monthly for 3 months. Rule out medical causes. Bell-and-pad alarm (Mowrer & Mowrer, 1938): classical conditioning.
Ch. 13 · 17 Gender dysphoria Show answer
Distress from incongruence for 6 months. Children: 6 of 8 indicators, including a strong desire to be another gender. Adolescents and adults: 2 of 6. The identity itself is not a disorder.
Ch. 13 · 18 Sexual dysfunctions Show answer
About 6 months plus distress; lifelong or acquired, generalized or situational; rule out medications. Sensate focus (Masters & Johnson, 1970). PLISSIT (Annon, 1976): Permission, Limited Information, Specific Suggestions, Intensive Therapy.
Chapter 14 Psychopharmacology for Counselors
Ch. 14 · 1 The counselor’s role with medication Show answer
Notice, note, notify: observe effects and adherence, document them in the client’s words, and share them with the prescriber under a release. Never start, stop, or change a dose.
Ch. 14 · 2 Task 5.4 (2027 NCE) Show answer
Document the self-reported effects of a client’s medication: what the client reports, since when, and how it affects functioning. Descriptive, not diagnostic.
Ch. 14 · 3 ACA Standards A.3 and C.2.a Show answer
A.3: when a client sees another mental health professional, request a release and work to build a collaborative relationship. C.2.a: practice within the boundaries of competence.
Ch. 14 · 4 Antidepressant onset Show answer
Usually 4–8 weeks. Sleep, energy, and appetite often improve before mood lifts.
Ch. 14 · 5 Antidepressant boxed warning Show answer
Suicidal thoughts and behaviors in children, adolescents, and young adults under 25, especially early in treatment and after dose changes. Issued 2004; extended to young adults 2007.
Ch. 14 · 6 Screen before a medication referral for depression Show answer
Ask about past mania or hypomania. A full manic episode that emerges during antidepressant treatment and persists beyond the drug’s effect supports bipolar I.
Ch. 14 · 7 Antidepressant discontinuation syndrome Show answer
Symptoms that can follow abruptly stopping an antidepressant; DSM-5-TR lists it among adverse effects of medication.
Ch. 14 · 8 Lithium Show answer
Mood stabilizer. Blood levels, kidney, and thyroid are monitored. Toxic levels sit close to therapeutic levels; dehydration, NSAIDs, and some blood pressure drugs raise levels.
Ch. 14 · 9 Lithium toxicity signs Show answer
Vomiting, diarrhea, tremor, poor coordination, slurred speech, confusion. Response: medical care now.
Ch. 14 · 10 First- vs. second-generation antipsychotics Show answer
First: movement effects (dystonia, akathisia, parkinsonism) and tardive dyskinesia. Second: weight, glucose, and lipids. Clozapine: regular blood tests. All: boxed warning for older adults with dementia.
Ch. 14 · 11 Benzodiazepines Show answer
Fast relief; dependence with steady use; abrupt stopping can cause seizures; overdose risk with opioids or alcohol (boxed warning updated 2020).
Ch. 14 · 12 Buspirone Show answer
An anti-anxiety medication taken daily for 3–4 weeks to reach full effect; not used as needed.
Ch. 14 · 13 Stimulants Show answer
Methylphenidate, amphetamines. Appetite loss, trouble sleeping, faster heart rate, higher blood pressure. Boxed warning updated 2023: misuse, addiction, overdose; never share; store securely.
Ch. 14 · 14 Serotonin syndrome vs. NMS Show answer
Serotonin syndrome: combined serotonergic drugs, onset within hours, twitching and overactive reflexes, fever. NMS: antipsychotics, builds over days, rigidity, fever. Both are emergencies.
Ch. 14 · 15 Methadone, buprenorphine, naltrexone Show answer
Full agonist (dispensed for opioid use disorder only by certified opioid treatment programs); partial agonist (no special federal waiver since December 2022); antagonist (started after withdrawal).
Ch. 14 · 16 Alcohol use disorder medications and naloxone Show answer
Alcohol: naltrexone, acamprosate, disulfiram. Naloxone: an opioid antagonist that reverses an overdose.
Chapter 15 Grief, Loss, and Life Transitions
Ch. 15 · 1 Kübler-Ross (1969) Show answer
Five stages (denial, anger, bargaining, depression, acceptance) drawn from interviews with dying patients. Not linear, not universal, and not a prescription for mourners.
Ch. 15 · 2 Worden’s four tasks Show answer
Accept the reality of the loss; process the pain; adjust to a world without the deceased; find an enduring connection while living on (Worden, 2018; first edition 1982).
Ch. 15 · 3 Grief counseling vs. grief therapy Show answer
Worden: grief counseling supports people with uncomplicated grief; grief therapy addresses complicated grief reactions.
Ch. 15 · 4 Dual process model Show answer
Stroebe and Schut (1999): healthy coping oscillates between loss-oriented and restoration-oriented stressors. Time away from grieving is adaptive.
Ch. 15 · 5 Continuing bonds Show answer
Klass, Silverman, and Nickman (1996): an ongoing inner bond with the deceased can be healthy. Challenges the older ideal of “letting go.”
Ch. 15 · 6 Disenfranchised grief Show answer
Doka (1989): grief that is not recognized or supported. Examples: a former spouse, a coworker, a miscarriage, a pet.
Ch. 15 · 7 Ambiguous loss Show answer
Boss (1999). Gone but here: a missing person, a deployed parent, a birth parent after adoption. Here but gone: dementia, addiction, brain injury. Goal: live with ambiguity, not closure.
Ch. 15 · 8 Anticipatory grief Show answer
Grief that begins before an expected death, as with terminal illness or a loved one’s dementia. Common in caregivers.
Ch. 15 · 9 Prolonged grief disorder (DSM-5-TR) Show answer
At least 12 months since the death (6 for children and adolescents); yearning or preoccupation nearly every day for at least a month; 3 of 8 symptoms; distress or impairment; beyond cultural norms.
Ch. 15 · 10 Prolonged grief disorder (ICD-11) Show answer
Code 6B42. At least 6 months after the loss; grief clearly beyond social, cultural, or religious norms (WHO, 2024).
Ch. 15 · 11 Grief vs. major depression Show answer
Grief: waves tied to reminders, self-esteem intact, wish to join the deceased. Depression: pervasive low mood, worthlessness. DSM-5 (2013) dropped the bereavement exclusion. No disorder: Z63.4, uncomplicated bereavement.
Ch. 15 · 12 What helps after a death Show answer
Normal grief: support, normalize, monitor. Universal intervention shows little lasting benefit (Currier et al., 2008). Complicated grief treatment outperformed interpersonal psychotherapy in a trial (Shear et al., 2005).
Ch. 15 · 13 Children of divorce Show answer
Most are resilient. Risk rises with ongoing parental conflict, weaker parenting, lost contact with a parent, and economic decline (Kelly & Emery, 2003). High conflict: parallel parenting.
Ch. 15 · 14 Stepfamilies and adoption Show answer
Stepfamily: the parent disciplines first while the stepparent builds a bond; loyalty binds are expected (Papernow, 2013). Adoption triad: adoptee, birth family, adoptive family; tell the child early.
Ch. 15 · 15 Schlossberg’s transition model Show answer
Transitions are anticipated, unanticipated, or nonevents. Coping depends on four S’s: situation, self, support, strategies (Anderson et al., 2012).
Ch. 15 · 16 End-of-life clients and the ACA Code (2014) Show answer
Standard B.2.b: with a terminally ill client considering hastening death, counselors may keep confidentiality, depending on law and after consultation. A.11.b bars referral based solely on personal values. The 2005 Code’s A.9.b, which let counselors decline end-of-life work, was dropped in 2014.
Chapter 16 Theories of Human Development
Ch. 16 · 1 Freud’s psychosexual stages Show answer
Oral (birth to about 1), anal (1–3), phallic (3–6; Oedipal conflict, superego forms), latency (6 to puberty), genital (puberty on). Fixation ties adult traits to a stage.
Ch. 16 · 2 Erikson’s first four crises Show answer
Trust vs. mistrust (hope); autonomy vs. shame and doubt (will); initiative vs. guilt (purpose); industry vs. inferiority (competence).
Ch. 16 · 3 Erikson’s last four crises Show answer
Identity vs. role confusion (fidelity); intimacy vs. isolation (love); generativity vs. stagnation (care); integrity vs. despair (wisdom).
Ch. 16 · 4 Freud vs. Erikson Show answer
Freud: drives, five stages ending with the genital stage at puberty, fixation. Erikson: social tasks, eight stages across the whole lifespan; crises can be revisited.
Ch. 16 · 5 Piaget’s four stages Show answer
Sensorimotor 0–2 (object permanence); preoperational 2–7 (symbols, egocentrism, centration, no conservation); concrete operational 7–11 (conservation, reversibility); formal operational 11+ (abstract, hypothetical).
Ch. 16 · 6 Assimilation vs. accommodation Show answer
Assimilation: fit a new experience into an existing schema. Accommodation: change the schema. Equilibration balances the two and drives stage change.
Ch. 16 · 7 Zone of proximal development Show answer
Vygotsky: the gap between what a learner can do alone and what the learner can do with guidance from someone more skilled.
Ch. 16 · 8 Scaffolding Show answer
Support matched to need and faded as skill grows. Term introduced by Wood, Bruner, and Ross (1976); the exam pairs it with Vygotsky’s ZPD.
Ch. 16 · 9 Piaget vs. Vygotsky Show answer
Piaget: the child discovers by acting alone; self-talk is egocentric. Vygotsky: learning happens through others and language; private speech guides thinking.
Ch. 16 · 10 Kohlberg’s levels and stages Show answer
Preconventional (1 punishment, 2 exchange); conventional (3 approval, 4 law and order); postconventional (5 social contract, 6 universal principles). Score the reason, not the choice.
Ch. 16 · 11 Gilligan Show answer
Ethic of care: own survival, then goodness as self-sacrifice, then balanced care for self and others. Critiqued Kohlberg’s all-boy samples and justice focus.
Ch. 16 · 12 Bowlby and Harlow Show answer
Bowlby: attachment is biologically based; internal working model; secure base (Ainsworth’s concept) and safe haven. Harlow (1958): monkeys chose the cloth surrogate; contact comfort, not food.
Ch. 16 · 13 Strange Situation patterns Show answer
Secure: seeks comfort, settles (sensitive care). Avoidant: ignores at reunion (rejecting care). Ambivalent: clings and resists (inconsistent care). Disorganized: no coherent strategy (Main & Solomon, 1990).
Ch. 16 · 14 Adult attachment styles Show answer
Bartholomew and Horowitz (1991): secure (self +, others +), preoccupied (self −, others +), dismissing (self +, others −), fearful (self −, others −).
Ch. 16 · 15 Bronfenbrenner’s systems Show answer
Micro: settings the person is in. Meso: links between them. Exo: settings never entered that still matter (a parent’s job). Macro: culture and laws. Chrono: change over time.
Ch. 16 · 16 Resilience Show answer
Positive adaptation despite adversity. Werner’s Kauai study: easy temperament, one caring adult, outside support. Masten (2001): “ordinary magic,” not a rare trait.
Chapter 17 Development Across the Lifespan
Ch. 17 · 1 Thomas and Chess: three temperament types Show answer
Easy (regular, positive, adaptable); difficult (irregular, intense, slow to adapt); slow-to-warm-up (wary at first, adapts with repeated exposure).
Ch. 17 · 2 Goodness of fit Show answer
Outcomes depend on the match between a child’s temperament and the environment’s demands, not on temperament alone (Thomas & Chess, 1977).
Ch. 17 · 3 Baumrind’s parenting styles Show answer
Authoritative (warm, firm, explained); authoritarian (firm, cold, “because I said so”); permissive (warm, few limits). A fourth, uninvolved, was added later.
Ch. 17 · 4 Uninvolved (neglectful) parenting Show answer
Low warmth and low demands: little monitoring or support. Completes the warmth-by-demands grid.
Ch. 17 · 5 Marcia’s identity statuses Show answer
Achievement (explored, committed); moratorium (exploring, not committed); foreclosure (committed, never explored); diffusion (neither) (Marcia, 1966).
Ch. 17 · 6 Foreclosure vs. achievement Show answer
Both are committed. Only achievement followed real exploration. A confident young adult who adopted the family plan unquestioned is foreclosed.
Ch. 17 · 7 Bullying Show answer
Repeated aggression with an imbalance of power (Olweus, 1993); it may be physical, verbal, relational, or electronic. Bully-victims tend to fare worst (Copeland et al., 2013).
Ch. 17 · 8 Responding to bullying Show answer
Protect the target, meet with each student separately, and use whole-school prevention. No peer mediation; zero-tolerance suspension or expulsion should not be the standard policy.
Ch. 17 · 9 School refusal vs. truancy Show answer
Refusal: anxious, parents know; treat with graded return. Truancy: concealed from parents, not driven by anxiety.
Ch. 17 · 10 Section 504 plan vs. IEP Show answer
504 (Rehabilitation Act of 1973): accommodations, such as extra time. IEP (IDEA): specialized instruction for an eligible disability.
Ch. 17 · 11 Levinson Show answer
Adult life as eras separated by transitions; midlife transition around 40 to 45 (Levinson et al., 1978).
Ch. 17 · 12 Social clock Show answer
Neugarten: a culture’s timetable for life events; being “off-time” can add stress (Neugarten et al., 1965).
Ch. 17 · 13 Fluid vs. crystallized intelligence Show answer
Fluid (novel reasoning) declines with age; crystallized (knowledge, vocabulary) holds or grows (Horn & Cattell, 1967).
Ch. 17 · 14 Theories of aging Show answer
Disengagement: older adults and society withdraw (Cumming & Henry, 1961). Activity: staying engaged predicts satisfaction. Continuity: people keep earlier patterns.
Ch. 17 · 15 Carter and McGoldrick’s family life cycle Show answer
Leaving home; the new couple; young children; adolescents (more flexible boundaries); launching (many exits and entries); later life (shifting generational roles).
Ch. 17 · 16 Abuse across the lifespan Show answer
Children: neglect is the most common type. Older adults: watch for financial exploitation. Domestic violence: Walker’s cycle (tension, incident, loving contrition); no couples work while violence continues.
Chapter 18 Career Development Theories
Ch. 18 · 1 Five families of career theory Show answer
Matching (fit): Parsons, Holland, TWA. Developmental (timeline): Ginzberg, Super, Gottfredson, Tiedeman. Needs: Roe. Learning: Krumboltz, SCCT. Narrative: Savickas.
Ch. 18 · 2 Parsons (1909) Show answer
Trait-and-factor: understand yourself, understand occupations, use true reasoning to match them. Planned and directed Boston’s Vocation Bureau, which opened in 1908.
Ch. 18 · 3 RIASEC Show answer
Holland’s six types: Realistic, Investigative, Artistic, Social, Enterprising, Conventional. Hexagon opposites: R–S, I–E, A–C.
Ch. 18 · 4 Congruence vs. consistency Show answer
Congruence: person type fits environment type. Consistency: the person’s top types are neighbors on the hexagon (RI consistent, RS not).
Ch. 18 · 5 Differentiation vs. identity (Holland) Show answer
Differentiation: one type clearly stands out; a flat profile is undifferentiated. Identity: clear, stable goals, interests, and talents.
Ch. 18 · 6 Theory of work adjustment Show answer
Dawis and Lofquist. Satisfaction (worker: rewards meet needs and values) + satisfactoriness (employer: abilities meet requirements) → tenure.
Ch. 18 · 7 Ginzberg’s periods Show answer
Fantasy (to about 11), tentative (11–17: interests, capacities, values, transition), realistic (17+: exploration, crystallization, specification). First “irreversible,” later lifelong.
Ch. 18 · 8 Super’s five stages Show answer
Growth (birth–14), exploration (15–24: crystallize, specify, implement), establishment (25–44), maintenance (45–64), disengagement, formerly decline (65+). Ages approximate.
Ch. 18 · 9 Super: self-concept and recycling Show answer
Choice implements a developing self-concept (Super, 1953). Maxicycle: the five stages across life. Minicycle: recycling at a transition, such as a layoff at 50. Career maturity: readiness for stage tasks.
Ch. 18 · 10 Life-Career Rainbow Show answer
Nine roles (child, student, leisurite, citizen, worker, spouse, homemaker, parent, pensioner) in four theaters (home, community, school, workplace). Role salience.
Ch. 18 · 11 Gottfredson’s circumscription Show answer
Orientation to size and power (3–5), sex roles (6–8), social valuation (9–13), internal unique self (14+). Leaves a zone of acceptable alternatives.
Ch. 18 · 12 Gottfredson’s compromise Show answer
In the original theory: give up interests first, prestige next, sex-type last. Compromise runs circumscription backward.
Ch. 18 · 13 Tiedeman and O’Hara; Roe Show answer
Tiedeman and O’Hara: anticipation (exploration, crystallization, choice, clarification), implementation (induction, reformation, integration); ego identity. Roe: family climate → toward or not toward people.
Ch. 18 · 14 Krumboltz’s four factors Show answer
Genetic endowment and special abilities; environmental conditions and events; learning experiences (instrumental, associative); task-approach skills. Produce self-observation and world-view generalizations.
Ch. 18 · 15 Planned happenstance Show answer
Mitchell, Levin, and Krumboltz (1999): create and use chance events. Five skills: curiosity, persistence, flexibility, optimism, risk taking. Indecision = open-mindedness.
Ch. 18 · 16 SCCT vs. career construction Show answer
SCCT (Lent, Brown, Hackett, 1994): self-efficacy, outcome expectations, goals; supports and barriers. Savickas: life themes, role models, motto; adaptability’s four Cs: concern, control, curiosity, confidence.
Chapter 19 Career Assessment, Information, and Counseling Practice
Ch. 19 · 1 Strong Interest Inventory Show answer
Interest inventory descended from the 1927 Strong Vocational Interest Blank. Reports General Occupational Themes (Holland), Basic Interest Scales, Occupational Scales, and Personal Style Scales.
Ch. 19 · 2 Occupational Scales (Strong) Show answer
Empirically keyed: compare the client’s likes and dislikes with those of people satisfied in each occupation. Similarity, not ability.
Ch. 19 · 3 Self-Directed Search (SDS) Show answer
Holland’s self-administered, self-scored inventory. Yields a three-letter RIASEC code that the client matches to occupations. Named in the 2027 specifications.
Ch. 19 · 4 MBTI in career work Show answer
Four Jungian preference pairs, 16 types. Describes preferences and style, not ability or pathology; its publisher says it should not be used for hiring.
Ch. 19 · 5 Interest vs. aptitude vs. values Show answer
Interest: would I like it? Aptitude: could I learn it? Values: would it matter to me? Only the client answers: should I choose it?
Ch. 19 · 6 ASVAB Show answer
Multiple-aptitude battery used for military selection and, through a career exploration program, in high schools.
Ch. 19 · 7 Card sort Show answer
Informal, qualitative assessment pioneered by Leona Tyler (1961). Clients sort occupation or value cards into piles and explain why; useful when norms fit poorly.
Ch. 19 · 8 Career indecision vs. indecisiveness Show answer
Indecision: normal, developmental, career-specific; resolved by exploration. Indecisiveness: chronic difficulty deciding across life areas, often anxiety-linked; needs personal counseling.
Ch. 19 · 9 Flat, low interest profile Show answer
No theme stands out. Explore low mood, worry, low self-efficacy, or limited experience before retesting or choosing the “highest” score.
Ch. 19 · 10 Using results (4K; 2B.10; 3A.5) Show answer
Results are hypotheses, not verdicts. Report them in terms the client understands (ACA Standard E.9.a), weigh with values and context, and let the client decide.
Ch. 19 · 11 O*NET Show answer
U.S. Department of Labor’s free online occupational database; replaced the Dictionary of Occupational Titles. Tasks, skills, wages, Job Zones, Interest Profiler (RIASEC).
Ch. 19 · 12 Occupational Outlook Handbook (OOH) Show answer
Bureau of Labor Statistics. Duties, work environment, education, pay, and job outlook (10-year projections); outlook and wage data updated annually.
Ch. 19 · 13 Jahoda’s latent deprivation model Show answer
Manifest function of work: income. Latent functions: time structure, social contact, shared purpose, status and identity, regular activity. Unemployment strips them all.
Ch. 19 · 14 Burnout (ICD-11) Show answer
An occupational phenomenon, not a medical condition: exhaustion, cynicism or mental distance from the job, reduced professional efficacy. Applies only to work (WHO, 2019).
Ch. 19 · 15 Financial stress Show answer
Debt is associated with depression, problem drinking, and suicide (Richardson et al., 2013). Address shame and conflict, assess risk; refer investment, tax, and legal questions.
Ch. 19 · 16 Transitions: IDEA and retirement Show answer
IDEA: transition services and postsecondary goals in the IEP in effect at 16. Retirement: Atchley’s phases (honeymoon, disenchantment, reorientation, stability) and continuity theory (1989).
Chapter 20 Case Conceptualization and Treatment Plans
Ch. 20 · 1 Case conceptualization Show answer
A working explanation of what is happening, why, how culture shapes it, and what will help. Links assessment and diagnosis to the plan; a revisable hypothesis.
Ch. 20 · 2 Sperry and Sperry’s four components (2020) Show answer
Diagnostic formulation (what?), clinical formulation (why?), cultural formulation (through whose eyes?), treatment formulation (what now?).
Ch. 20 · 3 Biopsychosocial model (Engel, 1977) Show answer
Biological, psychological, and social factors interact to produce health and illness. Named as required knowledge in the 2027 specifications.
Ch. 20 · 4 Prioritizing problems (3A.1) Show answer
Fire, roof, rooms: safety → crises and basic needs → the client’s priorities, weighed against the most impairing or maintaining problem.
Ch. 20 · 5 Parts of a treatment plan Show answer
Problem statements, long-term goals, objectives, interventions, modality (2I) and frequency, target dates, discharge criteria.
Ch. 20 · 6 Goal vs. objective Show answer
Goal: the broad destination, often in the client’s words. Objective: a measurable mile marker the client does or achieves, with a deadline.
Ch. 20 · 7 Objective vs. intervention Show answer
Objective: what the client will do or achieve. Intervention: what the counselor will do. “Counselor will teach…” is always an intervention.
Ch. 20 · 8 SMART (2027 specifications) Show answer
Specific, Measurable, Attainable, Realistic, Timely. Other sources say achievable, relevant, or time-bound; the test is the same.
Ch. 20 · 9 Spotting the best objective Show answer
A behavior or score, a number, and a realistic deadline. Distractors: “feel better,” “improve,” “gain insight,” or an impossible time frame.
Ch. 20 · 10 Three kinds of barriers Show answer
Practical (cost, transportation, child care, language): problem-solve. Clinical (substance use, medical, cognitive, crises): treat. Relational (alliance, culture, ambivalence): repair; MI.
Ch. 20 · 11 Strengths (3A.4; Standard A.1.d) Show answer
Past successes, skills, faith, family, community. With consent, enlist family, friends, or religious and community leaders as supports.
Ch. 20 · 12 Assessment, culture, development (3A.5, 3A.6, 5A) Show answer
Scores become baselines and targets. Goals fit the client’s values. Methods fit developmental level (play and caregiver coaching for young children).
Ch. 20 · 13 Counseling plans (Standard A.1.c) Show answer
Devised jointly; reasonable promise of success; fit abilities, temperament, development, and circumstances; reviewed and revised regularly; respect freedom of choice.
Ch. 20 · 14 When to revise the plan (3A.10) Show answer
Goal met, new problem, diagnosis changes, progress stalls, or the client asks. Revise with the client; document the date and reason.
Ch. 20 · 15 Contraindications (3A.8) Show answer
Safety now? Fit to condition? Fit to person? Examples: trauma processing amid danger; confrontational style in substance use; conjoint sessions amid fear of violence; weight-loss goals with an eating disorder.
Ch. 20 · 16 Behavioral management plan (3A.11) Show answer
Define and baseline → functional assessment (antecedents, consequences) → replacement behavior → reinforce → same rules in every setting → track and revise.
Chapter 21 Levels of Care, Collaboration, Monitoring, and Termination
Ch. 21 · 1 Level-of-care continuum Show answer
Outpatient → intensive outpatient (IOP) → partial hospitalization (PHP) → residential → inpatient. Choose the least restrictive level that is safe and allows progress; step up for risk, down as the client stabilizes.
Ch. 21 · 2 IOP vs. PHP Show answer
IOP: a few hours on several days a week. PHP: most of the day, most weekdays. In both, the client sleeps at home.
Ch. 21 · 3 Civil commitment cases Show answer
O’Connor v. Donaldson (1975): no confining a nondangerous person who can live safely in freedom. Addington v. Texas (1979): at least clear and convincing evidence. Olmstead v. L.C. (1999): the ADA favors community-based care.
Ch. 21 · 4 Referral as a process Show answer
Explain why → offer specific options → obtain a release → send what the new provider needs → confirm the client connected. Keep communication open with both (A.11.d).
Ch. 21 · 5 A.11.a vs. A.11.b Show answer
A.11.a: lacking competence, suggest referrals; if the client declines them, end the relationship. A.11.b: never refer solely because of personal values.
Ch. 21 · 6 Concurrent treatment (A.3) Show answer
The client sees another mental health professional: request a release to inform that professional and collaborate. Concurrent care is allowed.
Ch. 21 · 7 Interdisciplinary teams Show answer
D.1.c: focus on the client and add the counseling perspective. B.3.b: tell the client about the team and what is shared. D.1.d: raise ethical concerns within the team first.
Ch. 21 · 8 Wraparound’s ten principles Show answer
Family voice and choice; team-based; natural supports; collaboration (one plan); community-based; culturally competent; individualized; strengths-based; unconditional (the 2004 list said persistence); outcome-based (Bruns et al., 2008).
Ch. 21 · 9 Measurement-based care Show answer
Frequent brief measures, reviewed with the client, that drive decisions. One-time screening, infrequent measures, and feedback outside the session do not deliver the benefit (Fortney et al., 2017).
Ch. 21 · 10 Not on track Show answer
A client predicted to do poorly. Progress feedback helps these clients most (Lambert et al., 2018). Review the data together and revise the plan.
Ch. 21 · 11 Soliciting client feedback (4.12, new) Show answer
Ask about the process: Did you feel heard? Did we work on what mattered? Does the approach fit? Respond without defensiveness. Formative feedback shapes care; summative judges the result.
Ch. 21 · 12 Plan for disruption of service (3B.6, new) Show answer
Keeps each client’s care going through an interruption: covering clinician, crisis resources (988), how clients will be contacted, a fallback option, and access to records.
Ch. 21 · 13 Must vs. may terminate (A.11.c) Show answer
Must: the client no longer needs help, is not likely to benefit, or is being harmed. May: the counselor is in danger, or fees go unpaid as agreed. Pretermination counseling and referrals when necessary.
Ch. 21 · 14 Premature termination Show answer
The client stops coming: make reasonable outreach, send a closing letter inviting return and listing referrals, and document. Do not close silently or hold the slot indefinitely.
Ch. 21 · 15 Discharge vs. aftercare vs. follow-up Show answer
Discharge plan: when and how the client leaves (starts at admission). Aftercare plan: support afterward. Follow-up: a planned check that the client connected and gains are holding.
Ch. 21 · 16 Lapse vs. relapse Show answer
Lapse: a single slip. Relapse: a return to the old pattern. The abstinence violation effect turns one into the other (Marlatt & Gordon, 1985).
Chapter 22 The Helping Relationship and Core Skills
Ch. 22 · 1 Common factors (Rosenzweig, 1936) Show answer
Different therapies may work for shared reasons, such as catharsis, the therapist’s personality, and a consistent rationale, more than their unique techniques.
Ch. 22 · 2 Lambert’s estimates (1992) Show answer
Extratherapeutic client factors about 40 percent; common factors (relationship) about 30; expectancy about 15; techniques about 15. Rough estimates, not a statistical result.
Ch. 22 · 3 Working alliance (Bordin, 1979) Show answer
Agreement on goals, agreement on tasks, and an emotional bond. Applies across theories; predicts outcome (Flückiger et al., 2018). 2027 crosswalk: 3A.9.
Ch. 22 · 4 Stages of helping Show answer
Hill: exploration, insight, action. Egan: what is going on, what do I want instead, how do I get there. Ivey: empathic relationship, story and strengths, goals, restory, action.
Ch. 22 · 5 Role induction (4.9) Show answer
Orient the client: how counseling works, each person’s role, likely length, what to expect. Reduces premature dropout (Swift et al., 2012).
Ch. 22 · 6 SOLER (Egan) Show answer
Attending posture: face the client Squarely, Open posture, Lean toward, Eye contact, Relaxed. Adapt to culture.
Ch. 22 · 7 Open vs. closed questions Show answer
Open questions invite elaboration (“could” is the most open); closed questions get specifics. “Why” questions tend to provoke defensiveness.
Ch. 22 · 8 Paraphrase vs. reflection of feeling Show answer
Paraphrase restates content (what happened). Reflection of feeling names the emotion (how it felt).
Ch. 22 · 9 Reflection of meaning Show answer
Names the value or significance beneath the client’s words: why it matters.
Ch. 22 · 10 Summarizing Show answer
Ties several statements or themes together; used to open a session, mark a transition, or close.
Ch. 22 · 11 Carkhuff’s empathy scale (1969) Show answer
Five levels. 1–2 subtractive; 3 interchangeable (minimally facilitative); 4–5 additive.
Ch. 22 · 12 Confrontation Show answer
Supportively names a discrepancy: words vs. actions, two statements, or words vs. nonverbals. Needs an alliance first; Egan calls it challenging.
Ch. 22 · 13 Immediacy vs. self-disclosure Show answer
Immediacy: what is happening between counselor and client right now. Self-disclosure: the counselor’s own life, brief, for the client, then turn back.
Ch. 22 · 14 Broaching (Day-Vines et al., 2007) Show answer
Counselor initiates discussion of race, ethnicity, and culture. Continuum: avoidant, isolating, continuing/incongruent, integrated/congruent, infusing.
Ch. 22 · 15 Soliciting feedback (4.12) Show answer
New in 2027. Ask every session (e.g., Session Rating Scale); respond nondefensively. Feedback helps most with clients not on track (Lambert & Shimokawa, 2011).
Ch. 22 · 16 Ruptures (Safran & Muran, 2000) Show answer
Withdrawal: client moves away (vague, deferential, topic shifts). Confrontation: client moves against (complaints, criticism). Repair: notice, name, invite, own, adjust (4.15).
Chapter 23 Psychodynamic and Adlerian Approaches
Ch. 23 · 1 Id, ego, superego Show answer
Id: inborn drives, pleasure principle. Ego: mediator, reality principle. Superego: conscience (guilt) and ego ideal (pride).
Ch. 23 · 2 Freud’s levels of mental life Show answer
Conscious (aware now), preconscious (retrievable on demand), unconscious (largest; out of awareness, yet drives most behavior).
Ch. 23 · 3 Freud’s three anxieties Show answer
Reality: an outside threat. Neurotic: fear that id impulses will break through. Moral: fear of the superego’s punishment.
Ch. 23 · 4 Free association and dream analysis Show answer
Free association: report every thought, uncensored. Dream analysis: the remembered manifest content is read for its hidden latent content.
Ch. 23 · 5 Resistance and working through Show answer
Resistance: anything that blocks unconscious material (lateness, silence, topic changes); explored, not fought. Working through: repeating insight until change holds.
Ch. 23 · 6 Transference vs. countertransference Show answer
Transference: the client’s feelings from earlier relationships redirected onto the counselor. Countertransference: the counselor’s own reaction. Both occur in every approach.
Ch. 23 · 7 Repression vs. suppression Show answer
Repression: unconscious; material kept out of awareness. Suppression: a deliberate choice to set a worry aside; a mature defense (Vaillant).
Ch. 23 · 8 Projection vs. displacement Show answer
Projection: your feeling is seen in someone else (“He hates me”). Displacement: your feeling, aimed at a safer target (yelling at the dog).
Ch. 23 · 9 Reaction formation, rationalization, intellectualization Show answer
Reaction formation: the opposite of the real impulse. Rationalization: plausible excuses. Intellectualization: analysis in place of feeling.
Ch. 23 · 10 Teaching about defenses (5R, 4.11) Show answer
After trust exists; tentative (“I wonder if…”); normalizing; plain language; tied to the client’s goals. Never a label such as “You’re in denial.”
Ch. 23 · 11 Jung’s archetypes Show answer
Persona (public mask), shadow (disowned side), anima and animus (contrasexual sides), self (wholeness). They live in the collective unconscious.
Ch. 23 · 12 Individuation and psychological types Show answer
Individuation: integrating conscious and unconscious, chiefly the task of life’s second half. Types: introversion, extraversion, and four functions; the basis of the MBTI.
Ch. 23 · 13 Object relations and self psychology Show answer
Klein: splitting. Winnicott: good-enough mother, transitional object, holding environment. Mahler: separation-individuation, rapprochement. Kohut: mirroring and a cohesive self.
Ch. 23 · 14 Adler’s core concepts Show answer
Social interest (the yardstick of health); inferiority feelings and striving for superiority; style of life; fictional finalism; basic mistakes; life tasks of work, friendship, love.
Ch. 23 · 15 Adlerian phases and techniques Show answer
Relationship, assessment (early recollections, family constellation), insight, reorientation; encouragement throughout. Acting as if, spitting in the soup, catching oneself, push-button, the question.
Ch. 23 · 16 Dreikurs’s goals of misbehavior Show answer
Attention (adult feels annoyed), power (angry), revenge (hurt), display of inadequacy (helpless). Natural consequences happen on their own; logical consequences are arranged and related.
Chapter 24 Humanistic, Existential, and Gestalt Approaches
Ch. 24 · 1 Maslow’s hierarchy Show answer
Physiological, safety, love and belonging, esteem, self-actualization. Lower needs must be partly met first; the order is not rigid. Maslow called humanistic psychology the “third force.”
Ch. 24 · 2 Deficiency vs. growth needs Show answer
Deficiency needs motivate when they are lacking; growth needs drive self-actualization. Peak experiences: brief moments of awe and wholeness (Maslow, 1962).
Ch. 24 · 3 Actualizing tendency Show answer
Rogers: the inborn drive toward growth. The counselor provides conditions in which it can operate.
Ch. 24 · 4 Conditions of worth and incongruence Show answer
Conditional regard becomes conditions of worth, which split the self-concept from experience. The incongruence produces anxiety and defensiveness.
Ch. 24 · 5 Rogers’s three phases Show answer
Nondirective (1940s), client-centered (1950s), person-centered (later, extended to groups, education, and conflict).
Ch. 24 · 6 Rogers’s six conditions (1957) Show answer
Psychological contact; client incongruent and vulnerable; counselor congruent; unconditional positive regard; empathic understanding; client perceives the empathy and regard at least minimally. “Necessary and sufficient.”
Ch. 24 · 7 The core conditions Show answer
Congruence (genuineness), unconditional positive regard, accurate empathic understanding. Regard means accepting the person, not approving every behavior.
Ch. 24 · 8 The person-centered response Show answer
Reflects the client’s feeling and meaning in the client’s frame, then stops. No advice, “why” questions, reassurance, or interpretation.
Ch. 24 · 9 Frankl and logotherapy Show answer
Will to meaning is the primary motive. Meaning comes through deeds, through love and experience, and through one’s attitude toward unavoidable suffering. Existential vacuum: life without meaning.
Ch. 24 · 10 Paradoxical intention vs. dereflection Show answer
Paradoxical intention: wish for or produce the feared symptom. Dereflection: turn attention from self-observation to people and purposes beyond the self.
Ch. 24 · 11 Rollo May Show answer
Normal anxiety fits the threat and can spur growth; neurotic anxiety is out of proportion and relies on repression. Existence (1958) brought existential thought to the U.S.
Ch. 24 · 12 Yalom’s ultimate concerns Show answer
Death, freedom (with responsibility), isolation, meaninglessness. The goal is to face the anxiety they stir, not remove it.
Ch. 24 · 13 Gestalt core ideas Show answer
Fritz and Laura Perls, Paul Goodman; founding text by Perls, Hefferline, and Goodman (1951). Here and now; ask what and how, not why; figure and ground; unfinished business; holism; “I” statements.
Ch. 24 · 14 Contact disturbances Show answer
Introjection (swallowing values whole), projection (disowned traits seen in others), retroflection (turned back on oneself), deflection (dodging), confluence (no self–other boundary).
Ch. 24 · 15 Gestalt experiments Show answer
Empty chair; two-chair (top dog vs. underdog); exaggeration; reversal; dream work (speak as each element); language changes (“won’t” instead of “can’t”). Layers of neurosis: phony, phobic, impasse, implosive, explosive.
Ch. 24 · 16 Psychodrama and contraindications Show answer
Psychodrama (Moreno): protagonist, director, auxiliary egos, stage. Confrontive experiments wait until a client in crisis, psychosis, or dissociation is stable (2027 task 3A.8).
Chapter 25 Behavioral and Learning Approaches
Ch. 25 · 1 Classical conditioning (Pavlov) Show answer
A neutral stimulus paired with an unconditioned stimulus (food) becomes a conditioned stimulus that triggers a conditioned response (salivation) by itself. The response is reflexive, not chosen.
Ch. 25 · 2 Extinction vs. spontaneous recovery Show answer
Extinction: the conditioned stimulus appears without the unconditioned stimulus, and the response fades. Spontaneous recovery: the extinguished response briefly returns after a rest.
Ch. 25 · 3 Generalization vs. discrimination Show answer
Generalization: similar stimuli trigger the response (Little Albert feared a rabbit and a fur coat). Discrimination: only the original stimulus does.
Ch. 25 · 4 Little Albert and Peter Show answer
Watson and Rayner (1920) conditioned fear of a white rat in an 11-month-old by pairing it with a loud noise. Jones (1924) eased a boy’s fear of a rabbit by bringing it closer while he ate.
Ch. 25 · 5 Law of effect Show answer
Thorndike: responses followed by satisfying outcomes become more likely to recur. Skinner built operant conditioning on it.
Ch. 25 · 6 The operant 2 × 2 Show answer
Added + behavior up: positive reinforcement. Removed + up: negative reinforcement. Added + down: positive punishment. Removed + down: negative punishment.
Ch. 25 · 7 Negative reinforcement trap Show answer
If the behavior increases, it is reinforcement, never punishment. Avoidance is negatively reinforced by relief, which is why exposure blocks escape.
Ch. 25 · 8 Schedules of reinforcement Show answer
Continuous: fastest learning and fastest extinction. Fixed ratio: pause after reward. Variable ratio: highest, most extinction-resistant rate. Fixed interval: scallop. Variable interval: steady, moderate rate.
Ch. 25 · 9 Bandura’s Bobo doll (1961) Show answer
Children who watched an adult attack an inflatable doll copied the aggression without being reinforced: observational learning.
Ch. 25 · 10 Observational learning processes Show answer
Attention, retention, reproduction, motivation. Vicarious reinforcement: seeing a model rewarded increases imitation.
Ch. 25 · 11 Self-efficacy (Bandura, 1977) Show answer
Belief in one’s ability to perform a specific task. Sources: performance accomplishments (strongest), vicarious experience, verbal persuasion, physiological states.
Ch. 25 · 12 Reciprocal determinism Show answer
Bandura: person, behavior, and environment influence one another.
Ch. 25 · 13 Systematic desensitization vs. flooding Show answer
Desensitization (Wolpe, 1958): relaxation paired with a hierarchy, lowest step first; reciprocal inhibition. Flooding: the most feared item first, without escape, until anxiety falls.
Ch. 25 · 14 Operant techniques Show answer
Token economy (secondary reinforcers traded for backup reinforcers); response cost; time-out; shaping; chaining; Premack principle; extinction and the extinction burst.
Ch. 25 · 15 Behavioral management plan Show answer
Define the behavior observably; measure a baseline; record ABCs; hypothesize the function (get or escape); teach a replacement behavior with the same function; apply it consistently across settings.
Ch. 25 · 16 Biofeedback Show answer
Sensors show a body signal (muscle tension, skin temperature, heart rate variability, breathing, brain waves) in real time so the client learns to change it. Use only within your training and competence.
Chapter 26 Cognitive-Behavioral and Third-Wave Approaches
Ch. 26 · 1 First, second, and third waves Show answer
First: behavior therapy. Second: cognitive therapy, which changes the content of thoughts. Third: acceptance, mindfulness, and values, which change the relationship to thoughts (Hayes, 2004).
Ch. 26 · 2 REBT: ABC(DE) Show answer
Ellis. A, activating event; B, belief; C, consequence. Beliefs, not events, drive C. D, dispute the irrational belief; E, effective new philosophy.
Ch. 26 · 3 Irrational beliefs (Ellis) Show answer
Rigid musts and shoulds (“musturbation”), awfulizing, low frustration tolerance (“I can’t stand it”), and rating one’s whole self. Goal: unconditional self-acceptance.
Ch. 26 · 4 Healthy vs. unhealthy negative emotions; shame-attacking Show answer
REBT does not aim for no feeling: swap anxiety for concern, depression for sadness, guilt for remorse. Shame-attacking: do something harmlessly embarrassing to learn disapproval is bearable.
Ch. 26 · 5 Beck’s three levels of cognition Show answer
Automatic thoughts (situation-specific) → intermediate beliefs (rules, assumptions) → core beliefs, or schemas (global: “I am unlovable”).
Ch. 26 · 6 Cognitive triad Show answer
Beck: negative views of self, world, and future in depression.
Ch. 26 · 7 Beck’s distortions Show answer
All-or-nothing thinking, overgeneralization, selective abstraction, arbitrary inference, magnification and minimization, personalization.
Ch. 26 · 8 Collaborative empiricism Show answer
Beck’s stance: test a thought as a hypothesis together, using Socratic questioning, thought records, behavioral experiments, and activity scheduling. Beck runs the experiment; Ellis argues the case.
Ch. 26 · 9 Self-instructional training Show answer
Meichenbaum and Goodman (1971): counselor models aloud → child follows spoken instructions → self-instructs aloud → whispers → silent self-talk.
Ch. 26 · 10 Stress inoculation training (SIT) Show answer
Meichenbaum (1985): conceptualization → skill acquisition and rehearsal → application and follow-through, with graded real stressors.
Ch. 26 · 11 DBT essentials Show answer
Linehan. Biosocial theory (vulnerability plus invalidating environment). Acceptance and change. Individual therapy, skills group, phone coaching, consultation team. Diary card; chain analysis.
Ch. 26 · 12 DBT modules and targets Show answer
Accept: mindfulness, distress tolerance. Change: emotion regulation, interpersonal effectiveness. Targets: life-threatening → therapy-interfering → quality-of-life-interfering behavior.
Ch. 26 · 13 ACT hexaflex Show answer
Acceptance, cognitive defusion, present moment, self-as-context, values, committed action → psychological flexibility. Problems: fusion and experiential avoidance. Judge by workability.
Ch. 26 · 14 MBCT vs. MBSR Show answer
MBCT (Segal, Williams, Teasdale): eight-week group to prevent depressive relapse in remission; decentering. MBSR (Kabat-Zinn): stress and pain broadly.
Ch. 26 · 15 CBT-SP Show answer
Teens after an attempt (Stanley et al., 2009). Session 1: written safety plan and chain analysis. Then skills, family sessions, and a relapse prevention task (imagine the crisis, rehearse skills).
Ch. 26 · 16 Teaching a skill (task 4.3) Show answer
Instruct → model → rehearse → feedback and coaching → homework → generalize. A handout alone is psychoeducation (task 4.11).
Chapter 27 Reality, Postmodern, and Brief Approaches
Ch. 27 · 1 Glasser’s five basic needs Show answer
Survival, love and belonging, power, freedom, and fun. In choice theory, all behavior is a chosen attempt to meet them (Glasser, 1998).
Ch. 27 · 2 Quality world Show answer
A person’s inner album of the people, things, and beliefs that best satisfy their needs. Wants in WDEP come from here.
Ch. 27 · 3 Total behavior Show answer
Acting, thinking, feeling, and physiology. We directly control acting and thinking; feeling and physiology follow. Hence “depressing,” not “depressed.”
Ch. 27 · 4 Reality therapy: what it ignores Show answer
Little attention to the past, transference, the unconscious, or excuses. No criticism or punishment; the counselor never gives up.
Ch. 27 · 5 WDEP (Wubbolding) Show answer
Wants, Doing and direction, Evaluation, Planning. Evaluation (“Is it getting you what you want?”) is the heart of the method.
Ch. 27 · 6 Reality therapy plans Show answer
Simple, attainable, immediate, controlled by the client, and committed to. A failed plan is revised, not punished or excused.
Ch. 27 · 7 Social constructionism Show answer
The postmodern premise that reality is built in language and relationships. The client is the expert; the counselor is a curious collaborator.
Ch. 27 · 8 SFBT basics Show answer
de Shazer, Berg, and colleagues. Focus on solutions, not causes. If it works, do more of it; if not, do something different. Small changes grow.
Ch. 27 · 9 Miracle question Show answer
“If the problem vanished overnight, what would you notice first tomorrow?” Pictures the future and defines concrete goals (de Shazer, 1988).
Ch. 27 · 10 Exception, scaling, coping questions Show answer
Exception: when is the problem absent or smaller (past)? Scaling: 0 to 10 today, and one point higher? Coping: how have you kept going?
Ch. 27 · 11 Visitor, complainant, customer Show answer
SFBT readiness. Visitor: sees no problem. Complainant: wants someone else to change. Customer: ready to act.
Ch. 27 · 12 Narrative therapy Show answer
White and Epston (1990). Problem-saturated stories; externalizing; deconstruction; unique outcomes; re-authoring; therapeutic letters and certificates.
Ch. 27 · 13 Exception vs. unique outcome Show answer
SFBT exception builds behavior: do more of it. Narrative unique outcome builds identity: what does it say about who you are?
Ch. 27 · 14 MI essentials Show answer
Miller and Rollnick. Resolve ambivalence. Spirit: collaboration, acceptance, compassion, evocation (empowerment in the 2023 edition). Processes (tasks in 2023): engaging, focusing, evoking, planning. OARS.
Ch. 27 · 15 Change talk vs. sustain talk vs. discord Show answer
Change talk: DARN (desire, ability, reasons, need) and CAT (commitment, activation, taking steps). Sustain talk: for the status quo. Discord: relationship friction.
Ch. 27 · 16 Stages of change Show answer
Precontemplation (never), contemplation (maybe), preparation (soon), action (now, under 6 months), maintenance (still, beyond 6 months). Relapse is recycling.
Ch. 27 · 17 Multicultural orientation (MCO) Show answer
A way of being, not a skill set (Owen et al., 2011; Davis et al., 2018). Pillars: cultural humility, cultural opportunities, cultural comfort (Davis et al., 2018).
Chapter 28 Couples and Family Counseling
Ch. 28 · 1 Systems vocabulary Show answer
Homeostasis: the pull toward balance. Feedback: negative restores, positive amplifies. Circular causality: everyone is cause and effect. Identified patient: carries the symptom. Equifinality: many paths, same outcome.
Ch. 28 · 2 First- vs. second-order change Show answer
First-order: behavior changes inside the same rules. Second-order: the rules change (Watzlawick et al., 1974; MRI).
Ch. 28 · 3 Bowen’s eight concepts Show answer
Differentiation of self, triangles, nuclear family emotional process, family projection process, multigenerational transmission process, emotional cutoff, sibling position, societal emotional process.
Ch. 28 · 4 Differentiation vs. fusion Show answer
Differentiation: thinking separate from feeling; oneself while connected. Fusion: emotional reactivity and loss of self in the family system (Bowen).
Ch. 28 · 5 Triangles Show answer
A tense two-person relationship pulls in a third person, often a child, to lower anxiety. The Bowenian counselor stays detriangulated.
Ch. 28 · 6 Emotional cutoff and the genogram Show answer
Cutoff: distance or no contact to manage unresolved tension; the tension remains. Genogram: map of at least three generations, Bowen’s assessment tool.
Ch. 28 · 7 Structural boundaries Show answer
Diffuse: enmeshment. Rigid: disengagement. Clear: closeness with autonomy. Parents in charge (hierarchy). Cross-generational coalition: parent and child against the other parent (Minuchin).
Ch. 28 · 8 Structural techniques Show answer
Joining (tracking, mimesis), enactment, boundary making, unbalancing, reframing, family mapping.
Ch. 28 · 9 Strategic therapy Show answer
Haley and Madanes: brief, problem-focused; symptoms serve a function and reflect hierarchy problems. Directives (straight or paradoxical), prescribing the symptom, ordeals, pretend techniques.
Ch. 28 · 10 MRI and Milan Show answer
MRI: attempted solutions maintain the problem; interrupt them. Milan (Selvini Palazzoli et al.): hypothesizing, circular questioning, neutrality, positive connotation.
Ch. 28 · 11 Satir and Whitaker Show answer
Satir: placating, blaming, super-reasonable (computing), irrelevant (distracting) vs. congruent leveling; family sculpting, family reconstruction. Whitaker: symbolic-experiential; use of self, absurdity, co-therapist.
Ch. 28 · 12 Four Horsemen and antidotes Show answer
Criticism: gentle start-up. Contempt: culture of appreciation. Defensiveness: take responsibility. Stonewalling: physiological self-soothing. Contempt is the strongest predictor of divorce.
Ch. 28 · 13 Gottman’s numbers Show answer
About 5 positive interactions for every negative one during conflict in stable couples. About 69% of conflicts are perpetual: manage them through dialogue, don’t expect to solve them.
Ch. 28 · 14 EFT Show answer
Johnson and Greenberg (1980s); attachment-based. The pursue–withdraw cycle is the enemy. Secondary emotions (anger) cover primary ones (fear). Stages: de-escalate, restructure interactions, consolidate.
Ch. 28 · 15 IFS Show answer
Schwartz: the mind is a system of parts. Managers (proactive), firefighters (reactive), exiles (hurt). No bad parts. Goal: Self-leadership.
Ch. 28 · 16 Safety and ethics in couples work Show answer
Screen each person individually; fear or coercive control contraindicates conjoint work. Define the client (A.8) and secrets policy (B.4.b) before disclosures.
Chapter 29 Crisis Intervention and Trauma-Informed Care
Ch. 29 · 1 Crisis Show answer
A temporary state in which usual coping fails to manage an event as the person perceives it. Time-limited; a turning point toward growth or decline; not a disorder.
Ch. 29 · 2 Crisis vs. emergency Show answer
Emergency: life in danger right now (overdose in progress, weapon drawn); call emergency services first. Crisis: coping has failed but no one is in immediate danger; counseling begins.
Ch. 29 · 3 Lindemann (1944) Show answer
Studied grief, notably among people bereaved by Boston’s 1942 Cocoanut Grove nightclub fire; acute grief follows a predictable course that brief help can ease. A founding study of crisis theory.
Ch. 29 · 4 Caplan (1964) Show answer
Crisis upsets equilibrium and is time-limited; intervention restores at least precrisis functioning. Three levels of prevention: primary (prevent), secondary (catch early), tertiary (limit impairment).
Ch. 29 · 5 Four types of crisis Show answer
James and Gilliland (2017): developmental (expected transitions), situational (sudden events), existential (purpose and meaning), ecosystemic (disasters striking a community).
Ch. 29 · 6 Six-step model Show answer
James and Gilliland (2017). Listening: define the problem, ensure safety, provide support. Acting: examine alternatives, make plans, obtain commitment. Assessment runs throughout.
Ch. 29 · 7 Seven-stage model Show answer
Roberts (2005): assess lethality and needs, establish rapport, identify problems, deal with feelings, generate alternatives, form an action plan, follow up.
Ch. 29 · 8 Directiveness in crisis work Show answer
Brief, active, present-focused. The counselor becomes more directive as the client’s functioning drops (James & Gilliland, 2017).
Ch. 29 · 9 Imminent suicide risk Show answer
Do not leave the client alone. Arrange an emergency evaluation in the least restrictive safe setting; voluntary before involuntary. Never a no-suicide contract.
Ch. 29 · 10 Involuntary commitment Show answer
Set by state law. Most states require mental illness plus danger to self or others; most also count grave disability (inability to meet basic needs).
Ch. 29 · 11 988 Suicide & Crisis Lifeline Show answer
Call, text, or chat. People do not have to be suicidal to contact it; veterans press 1 for the Veterans Crisis Line. Launched in 2022.
Ch. 29 · 12 Verbal de-escalation Show answer
Richmond et al. (2012): calm yourself; at least two arm’s lengths, exits clear; one voice, brief sentences; ask about wants and feelings; agree where possible; set limits; offer choices; debrief afterward.
Ch. 29 · 13 Cycle of violence Show answer
Walker (1979): tension building, acute battering incident, loving contrition (“honeymoon”), then renewed tension.
Ch. 29 · 14 Domestic violence lethality Show answer
Campbell et al. (2003): abuser’s access to a gun, past threats with a weapon, and separation (especially from a controlling abuser) raise homicide risk. Safety plan; no couples counseling while violence continues.
Ch. 29 · 15 Psychological first aid Show answer
Brymer et al. (2006), eight core actions: contact and engagement; safety and comfort; stabilization; information gathering; practical assistance; connection with social supports; information on coping; linkage with services. No debriefing for all.
Ch. 29 · 16 Postvention and trauma-informed care Show answer
Postvention (AFSP & SPRC, 2018): confirm facts; inform students in small groups, not by assembly or PA; no method details; screen; treat all deaths alike. Trauma-informed care (SAMHSA, 2014): realize, recognize, respond, resist retraumatization; six principles.
Chapter 30 Group Foundations, Types, and Stages
Ch. 30 · 1 Task/work group Show answer
One of ASGW’s four types (ASGW, 2000). Accomplishes a goal or product: committees, treatment teams. The focus is the work, not personal change. Verb: does.
Ch. 30 · 2 Psychoeducational group Show answer
Teaches skills and information to prevent problems: parenting, anger management, study skills. Structured curriculum; the leader sets the agenda.
Ch. 30 · 3 Counseling group Show answer
Relatively well-functioning members work on present, conscious concerns and interpersonal growth, with a here-and-now focus.
Ch. 30 · 4 Psychotherapy group Show answer
Remediates serious or long-standing problems; deeper and longer, and may reach past and unconscious material.
Ch. 30 · 5 Self-help vs. counselor-led Show answer
Self-help and peer-support groups (twelve-step fellowships) are peer-led. Counselors refer to them; a counselor-led group is never a self-help group.
Ch. 30 · 6 Open vs. closed groups Show answer
Closed: fixed membership after the start; faster cohesion. Open: members join as others leave; can run indefinitely, but repeated adjustment.
Ch. 30 · 7 Homogeneous vs. heterogeneous Show answer
Homogeneous: members share a concern; quick bonding and support. Heterogeneous: varied members; richer feedback that mirrors daily life.
Ch. 30 · 8 Group size Show answer
Interactional adult groups: about 7 or 8 members, within roughly 5 to 10 (Yalom & Leszcz, 2020). Children’s groups are smaller, with shorter sessions.
Ch. 30 · 9 ASGW best practice: three P’s Show answer
Planning, performing, processing (2007 guidelines; Thomas & Pender, 2008). Planning includes needs assessment, goals, structure, recruitment, screening, and evaluation. The 2021 Guiding Principles keep the arc: pre-group planning, facilitation, evaluation (McCarthy et al., 2022).
Ch. 30 · 10 Screening and protection (A.9.a, A.9.b) Show answer
Screen for members whose goals fit, who will not impede the group, and who will not be harmed; usually an individual interview. Then protect members from trauma.
Ch. 30 · 11 Group informed consent Show answer
Purpose, format, leader qualifications, risks, confidentiality’s parameters (B.4.a), including that members’ confidentiality cannot be guaranteed, attendance and outside-contact policies, and the right to leave.
Ch. 30 · 12 Tuckman’s stages Show answer
Forming, storming, norming, performing (1965); adjourning added by Tuckman and Jensen (1977).
Ch. 30 · 13 Corey’s stages Show answer
Pre-group, initial, transition, working, final, post-group. Transition = storming; working = norming and performing.
Ch. 30 · 14 Guests, rivals, family, alumni Show answer
Initial: polite guests. Transition: rivals testing the leader. Working: family that can be honest. Final: alumni carrying lessons home.
Ch. 30 · 15 Transition stage: leader response Show answer
Treat conflict and challenges as normal; engage them openly and without defensiveness; invite members to say their reactions in the group.
Ch. 30 · 16 Membership changes and endings Show answer
Newcomer: prepare individually; expect a brief return to trust issues. Leaver: invite them to tell the group. Ending: announce early; review, feedback, transfer, goodbye.
Chapter 31 Group Leadership, Therapeutic Factors, and Ethics
Ch. 31 · 1 Yalom’s 11 therapeutic factors Show answer
Instillation of hope, universality, imparting information, altruism, corrective recapitulation of the primary family group, socializing techniques, imitative behavior, interpersonal learning, cohesiveness, catharsis, existential factors (Yalom & Leszcz, 2020).
Ch. 31 · 2 Universality, cohesiveness, hope, altruism Show answer
“Me too” (the problem is shared) = universality. “We” (I belong) = cohesiveness. “She made it” = hope. “I gave” = altruism.
Ch. 31 · 3 Corrective recapitulation of the primary family group Show answer
Family-of-origin patterns replay with leaders (parent figures) and members (siblings) and are recognized and reworked.
Ch. 31 · 4 Interpersonal learning and the social microcosm Show answer
Over time, members act in the group as they do outside it. Feedback shows them their impact, and they try new behavior.
Ch. 31 · 5 Cohesiveness and catharsis Show answer
Cohesiveness is the group’s counterpart to the therapeutic relationship and a precondition for the other factors. Catharsis helps when paired with understanding, not on its own.
Ch. 31 · 6 Here-and-now and process illumination Show answer
Two steps: members interact in the present; the leader then helps them examine what just happened. Storytelling is turned toward feelings in the room.
Ch. 31 · 7 Linking vs. blocking Show answer
Linking connects members’ words, feelings, and themes, building universality and member-to-member talk. Blocking stops harmful behavior (scapegoating, gossip, pressured disclosure) and protects everyone involved.
Ch. 31 · 8 Cutting off vs. drawing out Show answer
Cutting off respectfully interrupts rambling or a member using up the time. Drawing out invites a quiet member to participate, without pressure.
Ch. 31 · 9 Effective feedback Show answer
Specific, behavioral (not about character), timely, and owned by the speaker (“I felt brushed aside”). The leader models giving and receiving it.
Ch. 31 · 10 Lewin’s leadership climates (1939) Show answer
Authoritarian (autocratic), democratic, laissez-faire. Exam default: democratic, shared leadership; laissez-faire leaves members adrift (Lewin et al., 1939).
Ch. 31 · 11 Four leader functions (1973) Show answer
Emotional stimulation, caring, meaning attribution, executive function. Best outcomes: caring and meaning attribution high; stimulation and executive function moderate (Lieberman et al., 1973).
Ch. 31 · 12 Co-leadership Show answer
Benefits: two perspectives, a modeled working relationship, coverage, support. Risks: competition, unresolved conflict, splitting (one leader cast as good, the other bad). Plan, debrief, use supervision.
Ch. 31 · 13 Benne and Sheats’s member roles (1948) Show answer
Task roles move the work (initiator, information seeker). Building and maintenance roles sustain relationships (encourager, harmonizer, gatekeeper). Individual roles serve one member at the group’s expense (aggressor, blocker, dominator).
Ch. 31 · 14 Problem behaviors Show answer
Monopolizing: cut off, link, explore. Scapegoating: block at once, protect, explore. Rescuing or advice-giving: redirect to one’s own experience. Silence: invite, never demand. Rule: protect, then explore.
Ch. 31 · 15 Outside contact and subgroups Show answer
Leaders explain in advance what outside contact can mean. Secrecy is the danger, so meaningful outside contact is brought into the group, not banned or ignored.
Ch. 31 · 16 Group ethics: ACA and ASGW Show answer
ACA (2014): A.9.a screening, A.9.b protecting members from trauma, B.4.a explaining confidentiality’s importance and parameters. ASGW: planning, performing, processing (2007); 2021 Guiding Principles; at least 10 hours as a group member in training.
Chapter 32 Core Conditions and the Counselor as a Person
Ch. 32 · 1 Rogers’s six conditions (1957) Show answer
Psychological contact; a client in a state of incongruence (vulnerable or anxious); a congruent counselor; unconditional positive regard; empathic understanding; and the client perceiving the empathy and regard.
Ch. 32 · 2 “Necessary and sufficient” Show answer
Rogers’s claim for his conditions (1957). Many now see them as necessary but not sufficient: groundwork, not the whole treatment.
Ch. 32 · 3 Empathy and outcome Show answer
A meta-analysis found empathy a moderately strong predictor of outcome (r = .28), holding across theoretical orientations (Elliott et al., 2018).
Ch. 32 · 4 Congruence vs. genuineness Show answer
Congruence: inner experience, awareness, and expression match. Genuineness: how that looks from outside, a real person rather than a façade. Rogers used the terms interchangeably.
Ch. 32 · 5 What congruence is not Show answer
Saying everything you feel. The congruent counselor admits reactions when asked and voices them briefly, only when that serves the client.
Ch. 32 · 6 Empathy, sympathy, overidentification Show answer
Empathy feels with the client. Sympathy feels for the client. Overidentification feels as the client, losing the “as if.”
Ch. 32 · 7 Attunement vs. responding (6G, 6H) Show answer
Empathic attunement senses what the client feels, moment to moment, voice and body included. Empathic responding communicates that understanding.
Ch. 32 · 8 Carkhuff’s scale (1969) Show answer
Levels 1–2 subtractive (miss, minimize, redirect); level 3 interchangeable (minimum helpful level); levels 4–5 additive (name what is implied).
Ch. 32 · 9 Additive empathy: timing Show answer
Use it once trust exists. Offered too early, naming what the client has not said feels like mind reading.
Ch. 32 · 10 The most empathic exam option Show answer
Names the feeling and its meaning, tentatively, and stops. Reassurance, advice, “why” questions, and imposed interpretations are subtractive.
Ch. 32 · 11 Unconditional positive regard Show answer
Acceptance of the client as a person with no conditions of worth; also called prizing. Not approval: you can prize a client and still challenge harmful behavior.
Ch. 32 · 12 Non-judgmental stance (A.4.b, A.11.b) Show answer
Avoid imposing personal values; never refer solely over a values difference. Not value-free: safety and ethics still apply.
Ch. 32 · 13 Alliance rupture Show answer
A strain over goals, tasks, or the bond. Repair is moderately linked to better outcomes (Eubanks et al., 2018).
Ch. 32 · 14 Confrontation vs. withdrawal ruptures Show answer
Confrontation: the client moves against the counselor (complaints, anger). Withdrawal: the client moves away (vague answers, sudden compliance, topic shifts).
Ch. 32 · 15 Conflict tolerance (6F; 2027 task 4.15) Show answer
Stay steady and nondefensive under criticism: name the strain, invite more, own your part, adjust. Explaining, defending, or referring are distractors.
Ch. 32 · 16 The counselor as a person (6A; 1B.11) Show answer
Core conditions are ways of being. Self-awareness lets you notice a reaction, bracket it in session, and examine it later in supervision.
Chapter 33 Multicultural and Social Justice Counseling
Ch. 33 · 1 Multicultural Counseling Competencies (1992) Show answer
Sue, Arredondo, and McDavis. Three areas: awareness of one’s own assumptions, values, and biases; understanding the client’s worldview; culturally appropriate interventions. Each has beliefs and attitudes, knowledge, and skills.
Ch. 33 · 2 MSJCC (2015) Show answer
Four domains: counselor self-awareness, client worldview, the counseling relationship, counseling and advocacy interventions. AKSA: attitudes and beliefs, knowledge, skills, and action (new). Endorsed by AMCD and ACA in 2015 (Ratts et al., 2016).
Ch. 33 · 3 MSJCC quadrants and levels Show answer
Counselor and client each hold privileged or marginalized statuses (four combinations). Intervention levels: intrapersonal, interpersonal, institutional, community, public policy, international and global.
Ch. 33 · 4 Fourth and fifth forces Show answer
Multiculturalism: the fourth force, with culture defined broadly so all counseling is multicultural (Pedersen, 1991). Social justice: the fifth force (Ratts, 2009).
Ch. 33 · 5 Sue’s worldview model (1978) Show answer
Locus of control × locus of responsibility. IC-IR: dominant U.S. view. EC-IR: self-blame. EC-ER: powerless before an unfair system. IC-ER: “I could succeed if the system were fair.”
Ch. 33 · 6 Collectivism and high-context communication Show answer
Consulting family before deciding may be collectivist, not enmeshed. High-context (Hall, 1976): meaning in relationship and nonverbal cues. Low-context: meaning stated explicitly. Indirectness is not evasiveness.
Ch. 33 · 7 Etic vs. emic Show answer
Etic: the same concepts applied to every culture. Emic: each culture understood on its own terms. Unexamined etic assumptions underlie cultural encapsulation.
Ch. 33 · 8 Berry’s acculturation strategies Show answer
Keep heritage + join new culture = integration (generally the best adjustment). New only = assimilation. Heritage only = separation. Neither = marginalization (generally the poorest) (Berry, 1997).
Ch. 33 · 9 Acculturative stress and the acculturation gap Show answer
Strain of adapting: language, discrimination, lost support, changed roles. Children often acculturate faster than parents, a gap linked to family conflict. DSM-5-TR Z code: acculturation difficulty.
Ch. 33 · 10 Levels of racism Show answer
Individual: a person’s beliefs and acts. Institutional: policies producing unequal outcomes regardless of intent. Cultural: one group’s values and products treated as the standard.
Ch. 33 · 11 Privilege, intersectionality, internalized oppression Show answer
Privilege: unearned, often invisible advantage (McIntosh, 1989). Intersectionality: overlapping identities create distinct experiences (Crenshaw, 1989). Internalized oppression: accepting the dominant culture’s negative messages about one’s group.
Ch. 33 · 12 Microaggressions (Sue et al., 2007) Show answer
Microassault: deliberate attack (a slur). Microinsult: demeans heritage or identity (a surprised “You’re so articulate”). Microinvalidation: denies experience (“I don’t see color”; “Where are you really from?”; “Anyone can make it if they work hard”).
Ch. 33 · 13 Broaching (Day-Vines et al., 2007) Show answer
The counselor initiates, early and ongoing. Continuum: avoidant, isolating, continuing/incongruent, integrated/congruent, infusing.
Ch. 33 · 14 Multicultural orientation (MCO) Show answer
Three pillars: cultural humility, cultural opportunities, cultural comfort (Davis et al., 2018). A way of being with clients rather than a set of techniques. Named in the 2027 NCE specifications.
Ch. 33 · 15 ACA Advocacy Competencies (2003; updated 2018) Show answer
Acting with: client/student empowerment, community collaboration, collective action (formerly public information). Acting on behalf of: client/student advocacy, systems advocacy, social/political advocacy (Toporek & Daniels, 2018).
Ch. 33 · 16 Advocacy and the ACA Code (2014) Show answer
Preamble: promoting social justice is a core value. A.7.a: advocate at individual, group, institutional, and societal levels when appropriate. A.7.b: get consent before advocating for an identifiable client.
Chapter 34 Identity Development and Diverse Populations
Ch. 34 · 1 Cross’s nigrescence model Show answer
Pre-encounter (race not salient) → encounter (an event makes race unavoidable) → immersion-emersion → internalization → internalization-commitment. First published 1971; revised in Cross (1991).
Ch. 34 · 2 R/CID model Show answer
Conformity → dissonance → resistance and immersion → introspection → integrative awareness. Applies to any person of color; grew from the 1979 Minority Identity Development model (Sue et al., 2022).
Ch. 34 · 3 Helms’s White racial identity model Show answer
Contact → disintegration → reintegration → pseudo-independence → immersion-emersion → autonomy (Helms, 1990). Reintegration retreats into blaming people of color; pseudo-independence accepts others intellectually but not emotionally.
Ch. 34 · 4 Phinney (1989) Show answer
Unexamined → search → achieved ethnic identity. Parallels Marcia’s statuses (diffusion or foreclosure, moratorium, achievement). Applies across ethnic minority groups.
Ch. 34 · 5 Poston (1990) Show answer
Personal identity → choice of group categorization → enmeshment/denial → appreciation → integration. Pressure to “pick a side” is stage 2; guilt and confusion follow.
Ch. 34 · 6 The four-beat arc Show answer
Most racial identity models run unaware → jolted → immersed → integrated. Learn each model’s first stage: pre-encounter (Cross), conformity (R/CID), contact (Helms), unexamined (Phinney), personal identity (Poston).
Ch. 34 · 7 Identity stage and the counseling relationship Show answer
Conformity: may prefer a White counselor. Resistance and immersion: may distrust one. Broach the difference and explore needs; do not defend, argue, or refer at once.
Ch. 34 · 8 Four dimensions of sex and gender Show answer
Sex assigned at birth, gender identity, gender expression, sexual orientation; each independent of the others. Gender dysphoria diagnoses distress, not identity.
Ch. 34 · 9 Cass (1979) Show answer
Confusion → comparison → tolerance → acceptance → pride → synthesis. Pride: immersion in the community and anger at heterosexism. Synthesis: orientation is one part of a whole self.
Ch. 34 · 10 Downing and Roush (1985) Show answer
Feminist identity development: passive acceptance → revelation → embeddedness-emanation → synthesis → active commitment.
Ch. 34 · 11 Minority stress (Meyer, 2003) Show answer
Stigma, not orientation, explains elevated risk. Distal stressors: discrimination, violence. Proximal stressors: expected rejection, concealment, internalized homophobia.
Ch. 34 · 12 Values conflicts with a client’s identity Show answer
Avoid imposing values and seek training (A.4.b) or consultation (C.2.e); do not refer based solely on personal values (A.11.b). The ACA opposes conversion therapy.
Ch. 34 · 13 Models of disability Show answer
Moral: whose fault? Medical: what is broken? Social (minority): what is in the way? (Olkin, 1999). Follow the client’s person-first or identity-first preference; accommodate (task 6.14).
Ch. 34 · 14 ASERVIC competencies Show answer
Fourteen competencies in six areas: culture and worldview, counselor self-awareness, human and spiritual development, communication, assessment, diagnosis and treatment (Cashwell & Watts, 2010). Explore faith in the client’s terms.
Ch. 34 · 15 Z65.8 vs. Z60.3 Show answer
Z65.8: moral, religious, or spiritual problem (renamed 2025). Z60.3: acculturation difficulty. Both are DSM-5-TR codes for a focus of clinical attention, not mental disorders (APA, 2022, 2025).
Ch. 34 · 16 Age, class, immigration, and interpreters Show answer
Ageism (Butler, 1969). Classism: fees, hours, transportation. Refugees and asylum seekers fled persecution; undocumented clients may fear exposure. Qualified interpreter, not the client’s child (A.2.c; task 5.7).