CHAPTER 11: Intervention

With Families

1. The nurse-therapist is counseling the Smith family: Mr. and Mrs. Smith, 10-year-old Rob, and 8-year-old Lisa. When Mr. and Mrs. Smith start to argue, Rob hits Lisa and Lisa starts to cry. The Smiths then turn their attention to comforting Lisa and scolding Rob, complaining that he is out of control and we dont know what to do about his behavior. These dynamics are an example of a. Double-bind messages. b. Triangulation. c. Pseudohostility. d. Multigenerational transmission. 2. Using Bowens systems approach with a family in therapy, the therapist would: a. Try to change family principles that may be promoting dysfunctional behavior patterns. b. Strive to create change in destructive behavior through improvement in communication and interaction patterns. c. Encourage increase in the differentiation of individual family members. d. Promote change in dysfunctional behavior by encouraging the formation of more diffuse boundaries between family members. 3. Using the structural approach with a family in therapy, the therapist would: a. Try to change family principles that may be promoting dysfunctional behavior patterns. b. Strive to create change in destructive behavior through improvement in communications and interaction patterns. c. Encourage increase in the differentiation of individual family members. d. Promote change in dysfunctional behavior by encouraging the formation of more diffuse boundaries between family members. 4. Using the strategic approach with a family in therapy, the therapist would: a. Try to change family principles that may be promoting dysfunctional behavior patterns. b. Strive to create change in destructive behavior through improvement in communication and interaction patterns. c. Encourage increase in the differentiation of individual family members. d. Promote change in dysfunctional behavior by encouraging the formation of more diffuse boundaries between family members. 5. Carol, a nurse in a family medicine outpatient clinic, conducts initial interviews when new families are referred. She has just finished interviewing a mother who has come to the clinic with her three children, ages 5, 7, and 11. The mother says to the oldest child, You have been such a help to me, playing with your brothers while I talk to the nurse. In assessing family interaction, the nurse recognizes this statement as a direct indicator of a. Family climate. b. Family members expectations. c. Handling differences. d. Self-concept reinforcement. 6. The intermittent exiting and entering of various family members and reestablishing of the bond of the dyadic couple relationship are characteristics associated with which stage of family development: a. The family joined through marriage/union. b. The family with adolescents. c. The family launching grown children. d. The family in later life. 7. The nurse psychotherapist is working with the Jones family in the outpatient mental health clinic. The husband says, We cant agree on anything! And it seems like every time we disagree on something it ends up in a screaming match. Which of the following prescriptions by the nurse represents a paradoxical intervention for the Jones family?

a. Mr. and Mrs. Jones must not have a disagreement for one full day. b. Mr. and Mrs. Jones will yell at each other on Tuesdays and Thursdays from 8:00 p.m. until 8:10 p.m. c. Mr. and Mrs. Jones must refrain from yelling at each other until the next counseling session. d. Mr. and Mrs. Jones must not discuss serious issues until they can do so without yelling at each other. 8. Mr. and Mrs. Jones have been married for 21 years. Mr. Jones is the family breadwinner, and Mrs. Jones has never worked outside the home. Mr. Jones has always made all the decisions for the family and Mrs. Jones has always been compliant. According to the strategic model of family therapy, this is an example of which of the following? a. Marital schism. b. Pseudomutuality. c. Marital skew. d. Pseudohostility. 9. Jack and Ann have come to the clinic for family therapy. They have been married for 18 years. Jack had an affair with his secretary 5 years ago. He fired the secretary and assures Ann and the nurse that he has been faithful ever since. Jack tells the nurse, We have never been able to get along with each other. We cant talk about anything...all we do is shout at each other. And every time she gets angry with me, she brings up my infidelity. I cant even imagine how many times each of us has threatened divorce over the years. Our kids dont have any idea what it is like to have parents who get along with each other. Ive really had enough! The nurse would most likely document which of the following in her assessment of this couple? a. Marital skew. b. Pseudohostility. c. Double-bind communication. d. Marital schism. 10. Mr. and Mrs. Smith and their 3 children (ages 5, 8, and 10) are in therapy with the nurse psychotherapist. Mrs. Smith tells the nurse that their marriage has been falling apart since the birth of their youngest child, Tom. She explains that they did not want a third child, and I became pregnant even after my husband had undergone a vasectomy. We were very angry, the pregnancy was a problematic one, and the child has been difficult since birth. We had problems before he was born, but since Tom was born, things have gone from bad to worse. No one can control him, and he is wrecking our family! The nurse assesses that which of the following may be occurring in this family? a. Scapegoating. b. Triangling. c. Disengagement. d. Enmeshment.