The Nature of Trauma and Dissociation Test

In order to receive a CE certificate for this module you have selected to undertake a multiple choice questionnaire. Please answer the questions below and submit. There are 37 questions and a total of 21 hours CE can be attained.

Upon submission, if you have scored at least 80%, you will be redirected to an evaluation form, which you must complete before you can claim your Certificate of Attendance.

Please click here to view / download a PDF overview of the questions below. This will help you make notes and answer the test questions as you review the module content.

Full Name

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PAPER - Complex PTSD and the dissociative disorders

1.

The new DSM-5 diagnostic manual includes the diagnoses of

Select one answer

Complex PTSD and other dissociative disorders

Disorders of Extreme Stress

Complex PTSD, Disorders of Extreme Stress and Dissociative Identity Disorder

Dissociative Identity Disorder (DID) and PTSD

2.

Some of the adaptations to psychotherapy treatment that are widely recommended for the dissociative disorders are

Select any that apply

A substantial focus in treatment on the trauma and abuse held to be at the origin of the dissociative disorder

A strong emphasis on transference interpretations

Emphasis on improving self-regulation skills and bodily awareness

Special attention to therapist self-care and effective boundaries

PAPER - A history of trauma and dissociation

3.

The concept of (psychic) trauma as used in psychotherapy and psychiatry was first used by

Select one answer

Sigmund Freud

Charcot and Janet

Jung

Hippocrates and the Ancient Greeks

4.

The term "dissociation" was historically

Select one answer

a new name only introduced in the 1980s

in regular use since the Enlightenment

first used in the 1880s and has continued to be used since then

mainly used between 1885 and 1940, and again since the 1970s

PAPER - The neurobiology of PTSD

5.

When as part of the response to stress or a shock the human body substantially increases the availability of noradrenaline (norepinephrine), this

Select any that apply

is called a response by the locus coeruleus - noradrenergic system

is the main cause of the development of PTSD

is called the 'fight or flight response'

has no impact on the brain whatsoever

6.

The hypothalamic-pituitary-adrenal (HPA) axis regulates the amounts of cortisol in the body. How can you best describe the conclusion from research about its relationship with PTSD?

Select one answer

It is unclear how it is related; various test populations of people with PTSD have abnormally low or abnormally high basal cortisol levels

PTSD leads to abnormally high cortisol levels without external stress factors

PTSD leads to abnormally low cortisol levels without external stress factors

Dr Jean Knox

7.

Jean Knox explains that it happens frequently in therapy with abused clients that they perceive the therapy and / or the therapist as abusive. Which of these are possible reasons for this?

Select any that apply

When the client is triggered, they can often only re-enact, as the original event was never verbalised. This prevents them from mentalising.

Therapy with abused clients requires a great deal of empathic relating on the part of the therapist.

Simply thinking about the mind and intentions of the abuser, as done or encouraged by the therapist, may feel as abuse and put the client into a rage.

The main helping dimension of therapy can feel persecutory to the client, and remind them, perhaps unconsciously, of being groomed by their abuser.

8.

When working with the persecution or drama triangle, it is important

Select one answer

to make frequent transference interpretations

that the therapist, when the client identifies with the persecutor, not collapse into a victim state but holds the client

that the therapist when the client experiences the therapist as persecutory, does not acknowledge any role in this

that the therapist says as little as possible

Dr Daniel Siegel

9.

Dissociation is:

Select one answer

segmenting the mind so that states are isolated from other states

identifying the symptoms of chaos and rigidity

another word for the freeze response

a description of the normal ability of human beings to have different states

10.

Integration is:

Select one answer

not biologically or interpersonally based, but purely a personal state of mind

enhanced by clearly understanding the differences between corpus callosum, prefrontal cortex and the hippocampus

the linkage of differentiated parts of the embodied mind

easier when someone has suffered trauma

Dr Philip Bromberg

11.

In Bromberg's clinical perspective, dissociation is

Select one answer

always pathological

normal and worked with therapeutically in patient and analyst.

normal and plays no role in psychotherapy.

12.

Developmental trauma

Select one answer

exists for everyone, and is a matter of degree.

exists for everyone to a similar extent.

is a less significant type of trauma.

rarely is a focus in psychotherapy.

Dr Doris Brothers

13.

The therapist can obtain good tip-offs to what is going on in treatment by

Select any that apply

bodily experiences

reflecting on his or her theoretical knowledge

movement

not talking too much

14.

Trauma often leads to

the relationship between therapist and client

constrictions and rigidities in relationships

problems in childhood

surprises

PAPER - Controversies about dissociation and the dissociative disorders

15.

Dissociative Identity Disorder (DID) may have origins in trauma or that are explained by a sociocognitive model; there are professional opinions and forms of research evidence on both sides, which have not yet resulted in a resolution of the controversy

Select one answer

True

False

16.

The main goal of psychotherapy with a fragmented personality

Select one answer

is to reform the patient's verbal interpretations

should be to give the patient insight in their problems

can be either achieving integration or not; professional opinion is divided about the best goal to adopt

PAPER - Controversies about post-traumatic stress disorder

17.

Which of the following statements about psychotherapy for PTSD is NOT backed by formal research evidence based on randomised controlled trials?

Select one answer

Trauma-focused CBT and EMDR have the strongest research backing of all therapies that have been tested

Stress debriefing shortly after traumatic events reduces the later development of PTSD

NICE guidelines suggest extending the number of psychotherapy sessions when trauma is more complex

A number of studies suggest that standard psychotherapy methods should be adapted for working with PTSD

18.

Tick the statement that cannot be made about EMDR

Select one answer

EMDR is a trauma-focused psychotherapy

EMDR has certain similarities with energy therapies

EMDR has a strong evidence basis showing its effectiveness in working with PTSD

EMDR is proven by research evidence to require eye movements or other bilateral stimulation for its effectiveness

Dr Pat Ogden

19.

These are important ideas used in sensorimotor psychotherapy:

Select any that apply

The language used does not matter

Making a clear distinction between a freeze response with high sympathetic arousal, and a feigned death response

It is best to warn patients not to follow their impulses during therapy

When patients' arousal has moved outside the "window of tolerance", make sure that that they are brought back soon by accessing somatic resources

20.

About therapeutic enactments one can say that

Select any that apply

They are there to learn from

They should be avoided

Enactments are not mistakes but opportunities

Enactments are a very productive form of body to body conversation

Dr Donnel Stern

21.

Tick the statement that does NOT apply to Dr Stern's theories of unformulated experience and the unconscious

Select one answer

Unformulated experience explains how Freudian repression works

Unformulated experience is a defensive process or a defence mechanism

Unformulated experience is a theory of the unconscious

The idea of unformulated experience goes back to HS Sullivan

22.

Tick the statement that does NOT apply to Donnel Stern's views about enactment

Select one answer

Enactment is the unconscious part of relatedness

Enactment is similar to projective identification (with some differences)

Enactment is the interpersonalisation of dissociation

Enactment is the only way that "Not-me" can become part of the treatment

Dr Onno van der Hart

23.

In van der Hart's structural dissociation theory, it is held that as a result of trauma the personality system typically falls apart into subsystems that are called

Select one answer

Emotional Parts (EP)

an Apparently Normal Part (ANP) and the Emotional Part(s) (EP)

id, ego and superego

parts

24.

In van der Hart's terminology, which of the following is NOT a phase in the standard phase-oriented treatment of dissociative disorders?

Select one answer

Working through the ramifications of the Oedipus complex

Personality reintegration and rehabilitation

Stabilisation

Integration of traumatic memories

Professor Brett Kahr

25.

As regards working with sexual fantasies

Select any that apply

it is important to maintain analytic neutrality

it is best not to talk about these unless the patient or the couple bring them up themselves

it will benefit the patient if the analyst / therapist can be non-judgemental about and not aroused by the fantasy

it can often be useful for treatment to talk about sexuality and sexual fantasies, and this may be facilitated by opening up the subject in the first session

26.

Sexual fantasy can

Select one answer

be traumatic

often be the key to psychopathology

be mixed up with other elements that make it very difficult for clients to continue to be in treatment

allow a person to take a traumatic experience and transform it into an experience that is pleasurable

Dr Isha Mckenzie-Mavinga

27.

What is the closest way of putting some of McKenzie-Mavinga's ideas about racism?

Select one answer

Racism and post-racism are important concepts with useful therapeutic implications

We need to accept that we have entered an era of post-racism

Racism only affects white people, and can be ignored when working with black clients

Racism continues to cause trauma and depression; there is no such thing as "post-racism"

28.

Which of these are useful learning points for psychotherapy?

Select any that apply

Identify and process don't go signals

Try to achieve "un-gagging"

Ask every client in the first session how they feel about working with a white therapist (if you are white)

Pay attention to the client's heritage

Alexandra Richman

29.

In working with a complex trauma client, it is

Select any that apply

essential to establish safety early on in the therapeutic relationship

important to have in mind the work as a sequence of three phases

important to interpret the transference

very worth thinking about installing a place of safety and connecting the client with resources

30.

According to Richman, Borderline Personality Disorder (BPD)

Select one answer

Should be clearly distinguished from Dissociative Identity Disorder

Should be worked with in a different way from working with dissociative disorders

Should not be used as a diagnosis

Can be seen as similar to DID, as a disorder of alternating dissociated self-states

Dr Felicity de Zulueta

31.

In working with abuse survivors, it is good to keep in mind

Select any that apply

the abuse triangle between abuser, victim and colluder

exactly what disorder they have been diagnosed with

what beliefs they have about violence

that there rarely is abuse without a triangle of abuse

32.

Fairbairn's theory of 'moral defence' is:

Select one answer

A description of what happens when a client in therapy only wants to discuss the moral aspects of what someone has done, and refuses to move on to any other considerations

A rationalisation that a client develops about having been good and justified in their actions, in the face of accusations by the therapist of immoral or perverse behaviour

Only useful when working with a religious client

An implicit conviction that (usually) a child develops, when it is abused, that the abuser actually is good, and that the child must have been bad to deserve the abuse

Dr Valerie Sinason

33.

Which of these are views of Valerie Sinason?

Select any that apply

It takes many generations to work through severe trauma

Corporal punishment of children, as legally allowable in the UK, is acceptable and does no long-term damage

On the question of goals in working with DID, in certain cases it is best not to try to achieve integration, but to help a client to stabilise and live with a certain dissociative structure

Ritual abuse does not exist

34.

In working with severe trauma and abuse survivors, it is found that most therapists

Select one answer

find it easy to deal with the sense of grievance of their clients

find it easy to understand what really happened in their clients' childhood and to be empathically attuned to their clients

need to fall back on the basics of their school of psychotherapy that they were trained in

have clear patterns of strengths and weaknesses - clients with whom they are made to do brilliant work, and clients with whom they are unable to get any results

Dr Allan Schore

35.

Describing psychotherapy as the "talking cure" has turned out to be inaccurate. Instead, it is

Select one answer

Completely based on making accurate interpretations

Soon fully to be replaced by the use of psychiatric drugs

An affect-communicating and affect-regulating cure

An exercise in intuition

36.

Which statement best summarises some points Schore is making?

Select one answer

Sensitivity and flexibility in the administration of therapeutic interventions produce better outcomes than the rigid application of principle

It does not matter whether or not ruptures occur during psychotherapy. It is all grist to the mill

Enactments are technical mistakes, and the more they can be avoided, the better the outcome of therapy

The therapist's ability to form an alliance with the client is only one of many elements that determine effectiveness and successful outcome

PAPER - Post-traumatic stress disorder and its treatment

37.

As psychotherapy for (simple) PTSD, there is strong research evidence for the effectiveness of

Select any that apply

short-term standard CBT

Trauma Focused CBT

EMDR

psychoanalysis