Psychotherapies — MCQs

Psychotherapies Indian Medical PG Practice Questions and MCQs

Question 71: Which of the following is NOT a mature defense mechanism?

A. Humor
B. Projection (Correct Answer)
C. Asceticism
D. Altruism

Explanation: **Explanation:** Defense mechanisms are unconscious psychological strategies used to cope with anxiety. According to Vaillant’s classification, they are categorized into four levels: Pathological, Immature, Neurotic, and Mature. **Why Projection is the Correct Answer:** **Projection** is classified as an **Immature defense mechanism**. It involves attributing one's own unacknowledged unacceptable feelings, impulses, or thoughts to another person (e.g., a patient who feels angry at their doctor may claim, "My doctor hates me"). Because it distorts reality and shifts internal conflict onto the external world, it is not considered mature. **Analysis of Incorrect Options:** * **Humor (Mature):** Using comedy to express feelings and thoughts without personal discomfort or an unpleasant effect on others. * **Altruism (Mature):** Dealing with stressors by dedicating oneself to meeting the needs of others, providing a sense of vicarious satisfaction. * **Asceticism (Mature):** Eliminating the pleasurable effects of experiences. It is often seen in adolescents who renounce immediate gratifications to focus on higher goals or values. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Mature Defenses (SASH):** **S**ublimation, **A**ltruism, **S**uppression, **H**umor. (Note: **Asceticism** and **Anticipation** are also mature). * **Suppression vs. Repression:** Suppression is the only **conscious** defense mechanism (Mature), while Repression is **unconscious** (Neurotic). * **Sublimation:** Channeling socially unacceptable impulses into socially productive ones (e.g., an aggressive person becoming a boxer). This is frequently tested as the "most mature" mechanism.

Question 72: Which of the following is NOT considered a biological method of treatment in psychiatry?

A. Electroconvulsive therapy
B. Sub-convulsive ECT
C. Psychosurgery
D. Aversion therapy (Correct Answer)

Explanation: **Explanation:** In psychiatry, treatments are broadly classified into **Biological (Somatic) therapies** and **Psychological therapies**. **Why Aversion Therapy is the correct answer:** Aversion therapy is a form of **Behavioral Therapy** based on the principles of **Classical Conditioning**. It involves pairing an undesirable behavior (e.g., alcohol consumption) with an unpleasant stimulus (e.g., electric shocks or emetic drugs like Disulfiram) to create a conditioned negative response. Since it focuses on modifying behavior through learning processes rather than direct physical manipulation of the brain or body chemistry, it is a psychological intervention, not a biological one. **Analysis of Incorrect Options:** * **Electroconvulsive Therapy (ECT):** A biological treatment that involves passing an electric current through the brain to induce a generalized seizure. It is used for severe depression and catatonia. * **Sub-convulsive ECT:** This refers to the application of electrical stimulus that fails to produce a seizure. While clinically ineffective for therapeutic purposes, it remains a biological intervention by nature. * **Psychosurgery:** A biological method involving surgical destruction or removal of specific brain tissues (e.g., Deep Brain Stimulation or Cingulotomy) to treat refractory psychiatric disorders like OCD. **High-Yield Clinical Pearls for NEET-PG:** * **Aversion Therapy Example:** Using **Disulfiram** for alcohol dependence (creates a toxic reaction when alcohol is consumed). * **Biological Therapies** include Pharmacotherapy, ECT, rTMS (Repetitive Transcranial Magnetic Stimulation), and Vagus Nerve Stimulation. * **Behavioral Therapy** is based on the work of Pavlov (Classical Conditioning) and Skinner (Operant Conditioning).

Question 73: Which of the following is associated with Madonna-Putana complex?

A. Female arousal disorder
B. Male hypoactive sexual desire disorder
C. Male erectile disorder (Correct Answer)
D. Anorgasmia

Explanation: ### Explanation The **Madonna-Putana complex** (also known as the Madonna-Whore complex) is a psychological concept first described by **Sigmund Freud**. It refers to a specific psychological conflict in men where they cannot experience sexual desire and romantic love simultaneously for the same woman. **Why Male Erectile Disorder is Correct:** In this complex, the man categorizes women into two groups: 1. **The Madonna:** Women he loves and respects (e.g., wife, mother figures). He views them as "pure" and "saintly," making it psychologically impossible for him to desire them sexually. 2. **The Putana (Whore):** Women he finds sexually attractive but cannot love or respect. Clinically, this manifests as **situational male erectile disorder**. The individual is physically capable of an erection but fails to achieve or maintain one with his partner (the "Madonna") because sexual arousal feels "degrading" or "incestuous" to her image. However, he remains fully potent with casual partners or sex workers (the "Putana"). **Why Other Options are Incorrect:** * **A & D (Female Arousal Disorder/Anorgasmia):** These are female sexual dysfunctions. The Madonna-Putana complex is specifically described in the context of male psychology and its impact on male sexual performance. * **B (Male Hypoactive Sexual Desire Disorder):** These patients do not lack desire entirely. They often have high libido but suffer from a "split" in their ability to direct that desire toward a loved partner. **High-Yield Clinical Pearls for NEET-PG:** * **Origin:** Psychoanalytic theory (Freud). * **Underlying Mechanism:** It is considered a failure of the integration of the **affectionate** and **sensual** currents of libido. * **Key Symptom:** Selective or situational impotence (Erectile Disorder). * **Treatment:** Long-term psychoanalytic psychotherapy to resolve unconscious conflicts regarding the perception of women.

Question 74: In which therapeutic approach is the therapist typically passive?

A. Classical psychoanalysis (Correct Answer)
B. Psychoanalytic psychotherapy
C. Both approaches
D. Neither approach

Explanation: In psychiatric practice, the level of therapist activity is a key differentiator between traditional and modified psychodynamic approaches. ### **Explanation of the Correct Answer** **Classical Psychoanalysis (Option A)** is characterized by the **passivity and neutrality** of the therapist. The therapist often sits out of the patient's sight (behind the couch) and adopts the role of a "blank screen" (tabula rasa). This passivity is intentional; it facilitates **Free Association** and the development of a **Transference Neurosis**, allowing the patient to project their unconscious conflicts onto the therapist without interference. The therapist intervenes minimally, primarily through interpretation. ### **Explanation of Incorrect Options** * **Psychoanalytic Psychotherapy (Option B):** Unlike classical analysis, this is a more flexible, face-to-face approach. The therapist is **more active and conversational**, focusing on current life stressors and ego-strengthening rather than solely on deep unconscious exploration. * **Both approaches (Option C):** Incorrect because the degree of activity is a defining boundary between the two. Psychoanalysis requires passivity, while psychotherapy requires an interactive therapeutic alliance. * **Neither approach (Option D):** Incorrect as passivity is a hallmark of the classical Freudian technique. ### **High-Yield Clinical Pearls for NEET-PG** * **Frequency:** Classical Psychoanalysis usually involves 4–5 sessions per week for several years; Psychoanalytic Psychotherapy is typically 1–2 sessions per week. * **The "Couch":** Used in Classical Psychoanalysis to encourage regression and free association; not typically used in psychotherapy. * **Goal:** The goal of Classical Psychoanalysis is **personality reconstruction**, whereas Psychoanalytic Psychotherapy aims for **symptom relief** or conflict resolution. * **Counter-transference:** In both, the therapist must monitor their own emotional reaction to the patient, but in classical analysis, maintaining neutrality is paramount to avoid contaminating the "blank screen."

Question 75: Which mature defense mechanism involves consciously postponing attention to a distressing impulse or conflict?

A. Sublimation
B. Suppression (Correct Answer)
C. Humor
D. Anticipation

Explanation: **Explanation:** The correct answer is **Suppression**. Defense mechanisms are unconscious psychological strategies used to cope with reality and maintain self-image. They are classified into four levels (Vaillant’s classification), ranging from pathological to mature. **1. Why Suppression is Correct:** Suppression is the **only conscious** defense mechanism. It involves the deliberate, voluntary decision to postpone paying attention to a distressing feeling, impulse, or conflict. For example, a student decides not to worry about a family problem until after their NEET-PG exam. Because it is a conscious choice to deal with the stressor at a more appropriate time, it is classified as a **Mature (Level IV)** defense mechanism. **2. Analysis of Incorrect Options:** * **Sublimation (Mature):** This involves transforming socially unacceptable impulses into socially productive and acceptable actions (e.g., channeling aggression into professional sports). Unlike suppression, this is an **unconscious** process. * **Humor (Mature):** Using comedy to express feelings and thoughts without personal discomfort and without producing an unpleasant effect on others. It allows the individual to face a harsh reality by focusing on its ironic aspects. * **Anticipation (Mature):** Realistically planning for future inner discomfort. It involves "practicing" or rehearsing emotional reactions to future stressful events (e.g., preparing for the grief of a terminally ill relative). **Clinical Pearls for NEET-PG:** * **High-Yield Distinction:** **Suppression** is conscious; **Repression** is unconscious. Repression is an "Immature/Neurotic" mechanism where the mind forcefully pushes painful thoughts into the unconscious. * **Mature Defense Mechanisms Mnemonic:** **SASH** (Sublimation, Anticipation, Suppression, Humor). * **Altruism** is another high-yield mature defense mechanism involving meeting the needs of others to vicariously experience gratification.

Question 76: "Castration anxiety" is seen in which phase of Sigmund Freud's psychosexual stages of development?

A. Oral
B. Anal
C. Phallic (Correct Answer)
D. Genital

Explanation: **Explanation:** The correct answer is **Phallic (Option C)**. According to Sigmund Freud’s theory of psychosexual development, the Phallic stage occurs between **3 to 6 years** of age. During this stage, the erogenous zone is the genitalia. This phase is characterized by the **Oedipus Complex** in boys, where the child develops unconscious sexual desires for the mother and views the father as a rival. **Castration anxiety** arises as the boy fears his father will punish him for these feelings by removing his penis. In girls, a parallel process called the **Electra Complex** occurs, involving "penis envy." **Analysis of Incorrect Options:** * **Oral (A):** Occurs from birth to 18 months. The focus is on the mouth (sucking/biting). Conflict centers on weaning; fixation leads to oral-aggressive or oral-dependent personalities. * **Anal (B):** Occurs from 18 months to 3 years. The focus is on bowel/bladder control. Conflict centers on toilet training; fixation leads to "anal-retentive" (organized/obsessive) or "anal-expulsive" (messy) traits. * **Genital (D):** Occurs from puberty onwards. It represents the maturation of sexual interests and the establishment of healthy heterosexual relationships. **High-Yield Clinical Pearls for NEET-PG:** * **Sequence:** Oral → Anal → Phallic → Latency → Genital (Mnemonic: **O**ld **A**ge **P**eople **L**ove **G**rapes). * **Latency Stage:** (6 years to puberty) is the only stage where sexual impulses are **dormant**; energy is channeled into social and intellectual pursuits. * **Resolution:** Castration anxiety is resolved through **identification** with the same-sex parent, leading to the development of the **Superego**.

Question 77: Who gave the concept of latent and manifest dreams?

A. Benedict Morel
B. Masters and Johnson
C. Erik Erikson
D. Freud (Correct Answer)

Explanation: ***Freud*** - **Sigmund Freud** introduced the concepts of **latent** and **manifest dreams** as central to his **psychoanalytic theory** of dream interpretation. - According to Freud, the **manifest content** is the dream as it is remembered, while the **latent content** represents the hidden psychological meaning of the dream. *Benedict Morel* - **Benedict Augustin Morel** was a French psychiatrist known for the concept of **dégénérescence** (degeneration), which influenced early ideas about mental illness. - His work focused on the origins and classification of mental disorders, rather than dream analysis. *Masters and Johnson* - **William Masters and Virginia Johnson** were American sexologists known for their pioneering research into human sexual response and the treatment of sexual dysfunction. - Their work was primarily concerned with the **physiological aspects of human sexuality**, not dream interpretation. *Erik Erikson* - **Erik Erikson** was a developmental psychologist and psychoanalyst known for his theory on **psychosocial development**, which describes eight stages of human development. - While influenced by Freud, Erikson's focus was on the social and developmental aspects of personality, not the specific interpretation of dreams.

Question 78: A 42-year-old man with sexual interest in children (pedophilia) is given an electric shock each time he is shown a videotape of children. Later, he feels tense around children and avoids them. Which of the following management techniques does this example illustrate?

A. Implosion
B. Aversive conditioning (Correct Answer)
C. Biofeedback
D. Flooding

Explanation: ***Aversive conditioning*** - **Aversive conditioning** involves pairing an undesirable behavior or stimulus (e.g., sexual interest in children) with an unpleasant stimulus (e.g., electric shock). - The goal is to create an association between the undesirable behavior and the unpleasant consequence, leading to a reduction in the unwanted behavior or aversion to the stimulus. *Implosion* - **Implosion therapy** is a technique where the patient is asked to imagine vividly and intensely the most terrifying aspects of their phobic stimulus. - This method aims to extinguish the fear response by overwhelming the patient with anxiety-provoking imagery without any actual danger. *Biofeedback* - **Biofeedback** is a technique that teaches individuals to control involuntary physiological responses such as heart rate, muscle tension, or skin temperature. - It uses electronic sensors to monitor these responses and provide real-time feedback to the individual, allowing them to learn self-regulation. *Flooding* - **Flooding** is a behavioral therapy technique where an individual is exposed directly and intensely to a feared object or situation for a prolonged period. - The goal is to extinguish the fear response through habituation, by demonstrating that the feared stimulus is not dangerous despite the initial anxiety.

Question 79: Wrong statement about psychoanalysis is:

A. Transference is patient's feeling for therapist
B. Counter transference is clinician's feelings for patient
C. Parapraxis has meaning
D. Unguided communication has no meaning (Correct Answer)

Explanation: ***Unguided communication has no meaning*** - In **psychoanalysis**, every form of communication, including **unguided communication**, is believed to carry significant meaning, often reflecting unconscious thoughts or conflicts. - This statement is incorrect because the core tenet of psychoanalysis involves interpreting seemingly random or unguided expressions to uncover deeper psychological truths. *Transference is patient's feeling for therapist* - **Transference** is a central concept in psychoanalysis where a **patient's unconscious feelings and attitudes** from past relationships are redirected and expressed towards the therapist. - These feelings can be positive or negative and are crucial for understanding the patient's relational patterns. *Counter transference is clinician's feelings for patient* - **Countertransference** refers to the **therapist's emotional reactions** and unconscious feelings towards the patient, often triggered by the patient's transference. - Recognizing and managing countertransference is essential for maintaining objectivity and therapeutic effectiveness. *Parapraxis has meaning* - **Parapraxis**, also known as a **Freudian slip**, refers to an error in speech, memory, or action that is believed to reveal **unconscious thoughts or desires**. - Psychoanalysis posits that these slips are not random but instead carry hidden meaning, providing insight into the individual's unconscious mind.

Question 80: A child visits a doctor and experiences pain. So in subsequent visits, he ascribes pain to the sign of a white coat. This model of fear is described best as:

A. Classical conditioning (Correct Answer)
B. Extinction
C. Operant conditioning
D. Freudian theory

Explanation: ***Classical conditioning*** - **Classical conditioning** (Pavlovian conditioning) involves learning an association between a **neutral stimulus** (white coat) and an **unconditioned stimulus** (pain), leading to a conditioned response (fear of white coats). - In this scenario: **White coat (NS) + Pain (UCS) → Fear of white coat (CR)** - The child has associated the white coat with the unpleasant experience of pain, causing them to anticipate pain upon seeing a white coat in subsequent visits. - This is the classic example of **conditioned fear** or "white coat syndrome." *Extinction* - **Extinction** refers to the **waning of a conditioned response** when the conditioned stimulus is repeatedly presented without the unconditioned stimulus. - This option describes the eventual disappearance of the fear response after repeated painless visits, not its initial acquisition. *Operant conditioning* - **Operant conditioning** involves learning through **rewards and punishments** for voluntary behaviors (consequence-based learning). - The child's fear response is an **involuntary, automatic reaction** to a stimulus, not a voluntary behavior that is being reinforced or punished. *Freudian theory* - **Freudian theory** focuses on **unconscious desires, conflicts, and early childhood experiences** shaping personality and behavior through psychodynamic mechanisms. - While it addresses phobias through concepts like repression and defense mechanisms, it does not specifically describe the simple associative learning mechanism demonstrated in this scenario.

Practice by Chapter

Principles of Psychotherapy

Practice Questions

Psychodynamic Psychotherapy

Practice Questions

Cognitive-Behavioral Therapy

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Interpersonal Psychotherapy

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Supportive Psychotherapy

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Group Psychotherapy

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Family Therapy

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Couple Therapy

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Brief Psychotherapies

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Mindfulness-Based Therapies

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Integration of Psychotherapy and Pharmacotherapy

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Evidence-Based Psychotherapy Practices

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