Which of the following is NOT true about areas of competence?
A) ?They are narrower for beginning practitioners.
B) ?They are areas in which you compete with other professionals.
C) ?They are identified by the professional organization and licensing board.
D) ?They are within your scope of practice.
B
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A major contributor to the high standard of living in the US at the turn of the 20th century was
private, for-profit organizations. Indicate whether the statement is true or false
In which of the following models would a family be seen as an organism that is more than the sum of its parts, and in which the family constantly affects and is affected by its environment
a. the Systems model b. the Interrelational model c. the Medical model d. the Mixed-transactional model
Is there evidence of current or past history of manic episodes?
DSM Diagnosis 301.83 – Borderline Personality Disorder Rationale Marcy meets the criteria for borderline personality disorder as follows (five or more symptoms are required) (APA, 2000): 1) frantic efforts to avoid real or imagined abandonment: Marcy says that everyday she lives for the moment when her husband gets home from work; she also described becoming terrified of a pending breakup in her past relationships and would “beg and humiliate” herself so boyfriends would not leave. 2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation as demonstrated in her relationships with her sister- and mother-in-law. 3) impulsivity in spending (current) and previous substance use (during college) 4) chronic feelings of emptiness as described by Marcy 5) inappropriate, intense anger: Marcy’s presenting complaint was her anger 6) Affective instability due to a marked reactivity of mood: Marcy describes periods of “profound depression.” 7) Transient, stress-related paranoid ideation as related to her work experiences: Marcy’s explanation of why she was fired was, "They’re all a bunch of assholes anyway, who set me up to fail from the beginning." Marcy is 36, and these patterns have been ongoing since at least college. Additional Information Required A physical exam should be provided so that any medical reason for Marcy’s symptoms could be ruled out. The social worker should inquire further about the depressive periods and symptoms, the length of time they last, and how much the symptoms impair her functioning. Also, the social worker should assess evidence of any manic or hypomanic episodes to rule out Bipolar Disorder. Additionally, she should be asked about any suicidal thoughts or plans or attempts in the past. Further information about Marcy’s current relationship with her grandparents would be helpful. Finally, while information is given on Marcy’s current circumstances, as well as her youth up until college, not much is revealed about the period of time after Marcy graduated from college to the present. What were her symptoms like during this 15-year time span? Risk and Resilience Assessment Onset ? Marcy is female; 75% of BDP sufferers are female ? Marcy’s mother likely continued drinking while pregnant with Marcy ? Marcy endured physical and, presumably, emotional neglect during her formative attachment period ? Maternal abandonment (her mother’s inability to care for Marcy) ? Marcy’s grandmother told her that since her infancy Marcy has exhibited a difficult temperament. Protective factors for the onset of the disorder were the devoted nurturance and caregiving that Marcy’s grandparents provided her. Course Marcy is married, which generally acts as a protective influence. However, her husband seems to be enabling Marcy’s angry outbursts and her beliefs about people during her devaluation cycles. Although Marcy is estranged from her father, she describes close relationships with her husband, grandmother, and her husband’s family. She admits to having no friends outside the family. Marcy is employed, which means that she has some structure in her daily life, a helpful factor. She is intelligent, and no longer uses substances. She meets only minimal criteria for borderline personality disorder and none of the suicidal or self-mutilating behaviors that characterize many people with borderline personality disorder. She has been able to make it to the age of 36 without requiring treatment and seems motivated to feel better now. Indeed, since she is approaching 40, Marcy may begin to experience a gradual moderation and diminishing of symptoms. What additional techniques can be used to elicit further strengths from Marcy? Childhood adversity: ? How was she able to survive the difficult times of her childhood? What strengths did she draw upon? What resources did she develop as a result? Education and career: ? How was Marcy able to graduate from college? How was she able to choose a career path? (to get at how she was able to form stable parts of her identity) What strengths, qualities, and supports did she draw upon to achieve this? ? What are Marcy’s most significant accomplishments to date? How was she able to achieve these things? Relationships: ? How has she been able to make her marriage work? What patterns did she change to be able to stay in a relationship for this long? How did she do this? What strengths and qualities would her husband say she brings to the marriage? Substance use: ? How did she come to the decision to stop using drugs and to curtail her drinking? How was she able to do this once she made the decision? Exception-finding: ? Have Marcy identify a time that she was alone but felt all right. What was different about that time? What did she do differently? What was she saying to herself? Decisional balance about her belief systems, such as “I need unquestioning loyalty from the people in my life,” and “I either love you, or I hate you.” ? What does she get out of this belief (e.g., security, feels loved)? What does she lose (potential relationships, missed opportunities for growth, lack of authenticity in relationships, those who know her might fear her reactions)? Future without the problem: ? What will Marcy’s life be like as a result of coming to treatment? What will she be feeling/doing/saying? What will other people be noticing that is different about her? Treatment Marcy is relatively new to therapy and appears motivated to feel better. She has so far, however, proven unwilling to acknowledge her own contribution to her difficulties. At this point, she continues to view therapy as paying a friend to listen to her and “side with her” in her relationship difficulties. A supportive approach was taken initially while the social worker continued to make her assessment. The intentional focus was on Marcy’s present experience, incorporating her past only as a backdrop. Her social worker’s reflective listening, validation, and normalization were designed to help Marcy appreciate that many women have struggled in relationships the way she has, and that they have become able to experience greater stability and happiness. The treatment recommendation is to implement Dialectical Behavioral Training (DBT), which will be employed through individual and group modalities. DBT will help Marcy develop coping skills in the areas of emotional regulation, distress tolerance, interpersonal effectiveness, and identity confusion, and to correct maladaptive cognitions. Marcy will also be referred for a psychiatric assessment to determine if medication will ease her symptoms of depression, anger, and impulsivity. Critical Perspective Borderline Personality Disorder includes symptoms that overlap with several mood disorders, including major depression and bipolar disorder. Differentiating among these disorders is difficult but also critical for initiating appropriate interventions. In the women’s counseling center to which Marcy came, the policy was that personality disorders were not assigned. Therefore, in actuality she was given an adjustment disorder with depressed mood for her current work difficulties. However, treatment proceeded with Dialectical Behavior Therapy, and Marcy was to be referred out for the group component of DBT since no such group was offered at the women’s counseling center. The policy at the counseling center points to the stigma that may be experienced if a client is given a personality disorder. This case also points to the heterogeneity of symptoms that is present with borderline personality disorder. In her presentation, Marcy is much more high functioning than other people diagnosed with borderline personality disorder. She has job skills (though with a spotty work history) and is married. She does not have the same extent of impulsivity that other people with this diagnosis have, and she is not self-injurious. However, she has the core features of affective instability that defines the borderline personality
Which of the following is an example of a task group?
a. a group that engages in regular social outings b. an anti-bullying committee c. a group which uses cooperative games to build social skills d. educational workshops