False: In transference, the patient relates to the therapist as though he/she was a significant object from the past. In brief psychodynamic psychotherapy, transference is discussed and analysed (Gelder et al 2000, p. 1423; Sadock & Sadock 2005, p. 2641).

True: Brief psychodynamic psychotherapy is a time-limited therapy based on psychodynamic principles. It is useful in patients who present with a circumscribed set of problems with a focus that can be understood in dynamic terms; in individuals with transitional crises, e.g. parenthood, leaving home, abnormal grief reaction; PTSD; adolescents with emotional or conduct problems; and in issues of illness, treatment and decline in the elderly (Stein et al 1999, pp. 155–173).

True: Homework is not absolutely necessary for improvement in CBT. However, patients who engage in homework make quicker, longer lasting and more generalized progress. CBT for relationship difficulties involves helping the couple reformulate their problems and develop new rules in a spirit of collaboration and shared goals. Homework assignments often involve putting the new revised rules into practice, so that the couple can appreciate the level of functionality that is possible and make further adjustments as necessary (Sadock & Sadock 2005, pp. 2601, 2604).

True: Relaxation training is useful as a basic treatment for anxiety. The training consists of instructions that aid progressive muscle relaxation. CBT specifically targets cognitive, e.g. worry, and behavioural, e.g. avoidance, features. Combined cognitive and behavioural treatments are more effective than either treatment alone. CBT is the most effective psychological treatment for GAD. It reduces the severity of anxiety by about 50%. It is as effective as treatment with benzodiazepines in GAD (Gelder et al 2000, p. 791; Gelder et al 2006, p. 182; Johnstone et al 2004, p. 468).

False: A systematic review of psychological treatment for chronic and recurrent pain in children and adolescents concluded that there was sufficient evidence that relaxation and CBT reduced the severity and frequency of chronic headaches but little evidence that they improved non-pain outcomes (Ecclestone et al 2003).

True: In cognitive therapy, the therapist and the patient initially work on modifying negative automatic thoughts that cause distress for the individual. Only after some change in these automatic thoughts has occurred will the patient be able to engage in behavioural tasks, which then in turn facilitate further challenging of automatic thoughts by providing evidence to the contrary (Hawton et al 1988, p. 200).

True: Collaborative empiricism refers to the collaborative nature of the empirical enterprise central to cognitive therapy. In cognitive therapy, the therapist actively interacts with the patient, making it a collaborative venture, in contrast to some other forms of psychotherapy. The therapy is structured in order to engage the participation of the patient in the empirical investigation of their thoughts, inferences, conclusions and assumptions (Beck et al 1979; Johnstone et al 2004, p. 315; Sadock & Sadock 2005, p. 2599).

False: Contingency management refers to a group of behavioural procedures based on the principle that behaviours persist as a result of reinforcement by some of their consequences. If these consequences are altered then the target behaviour will change. The reinforcement is withdrawn from the undesirable behaviours and is made contingent only on desirable behaviours. Contingency management is used to manage behavioural problems in people with learning disabilities and autism (Gelder et al 2006, p. 592).

False: Countertransference refers to the emotional response of the therapist towards the patient. In psychodynamic therapy this is considered to be an important source of information regarding the workings of the internal world of the patient. Experienced therapists are more able to recognize the counter-transference, but not able to avoid it (Brown & Pedder 1991, p. 61; Gelder et al 2006, pp. 584, 600).

True: Circular questioning is an original feature of the Milan Associates Systemic model. It refers to a way of questioning in which responses are used to construct further questions that seek to bring out connections between behaviours, beliefs and relationships of individuals within the family. It allows the therapist and family to understand family processes from the perspectives of different family members and in doing so develop a complex picture of relationships, behaviours and beliefs (Gelder et al 2000, p. 1478; Stein et al 1999, p. 280).

True: Triangulation refers to the process in which parents in conflict attempt to win the sympathy and support of their child, who is recruited by one parent as an ally in the struggle with the other. Triangulation may also refer to the process in which parents focus on a behavioural or health problem of the child as a strategy for diffusing relationship problems (Dallos & Draper 2000, p. 39; Sadock & Sadock 2005, p. 2244).

True: The therapist in structural family therapy brings about change in family patterns to a healthier and more functional form based on a normative model of healthy family functioning using a more directive approach. In structural family therapy, the therapist negotiates a leadership role with the family, uses genograms, elaborates the structure of the family in terms of subsystems and relationships, makes use of reframing and uses directive and restructuring interventions (Stein et al 1999, p. 276).

True: Family systems, like other systems, have a tendency to maintain balance and equilibrium. Systems theory of family therapy suggests that a symptom in one or more members of the family is in fact an attempt to maintain equilibrium and attempts to change this will be met with resistance (Dallos & Draper 2000, p. 35; Sadock & Sadock 2005, p. 2587).

True: The work of Foulkes was fundamental in the development of group analysis. He also founded the Institute of Group Analysis in London.

True: Yalom described 11 therapeutic factors in group therapy: instillation of hope, universality, imparting information, altruism, corrective recapitulation of the primary family group, development of socializing techniques, imitating adaptive behaviours, interpersonal learning, group cohesiveness, catharsis and existential factors. Skills-based groups tend to focus more on imparting information to their members (Gelder et al 2006, p. 603; Johnstone et al 2004, p. 321; Sadock & Sadock 2005, p. 2570; Yalom 1995).

False: Direct advice from members invariably occurs in group psychotherapy. In dynamic groups this is usually in the early stages of the group or at a later stage when the group is confronted with some difficulty leading to temporary regression. In dynamic groups, group conductors generally do not offer direct instruction but in other forms of group therapy this may form an important part of the programme. See also answer to Q15 (Gelder et al 2006, p. 603; Johnstone et al 2004, p. 321; Sadock & Sadock 2005, p. 2570; Yalom 1995).

True: Resistance in a group hinders the ability of the group to continue with its task. This may manifest as scapegoating, i.e. subclassifying a group of people and attacking them and/or monopolizing the group (Barnes et al 1999, p. 111).

True: Contract marital therapy involves an agreement between both partners to reward one another for behaviours and responses which each partner seeks from the other (Brown & Pedder 1991, p. 146).

False: Negative therapeutic reaction refers to the worsening or reappearance of symptoms following some progress in analysis. Initially it was thought of as an act of defiance but was later conceptualized as a paradoxical reaction to the accuracy of the interpretation. The negative therapeutic reaction is thought to be determined by aggressive and destructive instincts (Bateman & Holmes 1995, p. 165).

False: A diagnosis understandable in psychological terms in its own right is not an indicator of likely response to psychotherapy. It does, however, help the assessment of suitability for psychotherapy, aid decisions regarding what type of therapy may be beneficial and guide ongoing therapy itself (Mace 1995, p. 169).

True: Not all supportive psychotherapies are psychodynamic in orientation. A psychodynamic formulation is important in psychodynamic supportive therapy, but not necessarily in other forms of supportive therapy.

False: Normalization refers to the principle expressing the aims, attitudes and norms underpinning quality work with the mentally retarded. In essence it means making available to the mentally retarded the patterns and conditions in their everyday life as close to those of mainstream society as possible (Fraser & Kerr 2003, p. 2; Gelder et al 2000, p. 1503).

True: Horvath & Symonds (1991) conducted a meta-analysis of studies looking at working alliance and outcomes in psychotherapy. They were able to demonstrate a moderate but reliable association between good working alliance and a positive outcome in psychotherapy. They also found that ratings of the working alliance by clients and therapists were both associated with positive outcome in psychotherapy, though the therapist’s ratings were less predictive. They also concluded that the relation of the working alliance to outcome was independent of type of therapy and duration of treatment.

False: Assumptions or schemas in cognitive therapy refer to relatively stable cognitive structures developed as a means of organizing experiences and are part of normal cognitive development. Schemas influence automatic processes such as perception, affective responses and action responses. The dynamic unconscious is characterized by its use of primary process thinking. Primary process thinking displays the phenomena of displacement, condensation and symbolization and ignores categories of space and time. Secondary process thinking, on the other hand, obeys the laws of formal logic and grammar and is characteristic of conscious thinking (Beck et al 1979).

False: The working alliance is the agreement between patient and therapist that they will work together on the patient’s emotional or psychological problems. The transference relationship refers to the patient’s relationship to the analyst in which the individual transfers onto the analyst experiences, attitudes and feelings experienced in the past in relation to significant others (Butler & Pitt 1998, p. 54).