Noxious People. Joe Shannon, Ph.D. 6 hours of CE credit. 48 Questions

Transcription

1 Noxious People Joe Shannon, Ph.D. 6 hours of CE credit 48 Questions Noxious people are defined as problematic relationships that can engender mental or physical illness in others. This program will help you recognize and deal more effectively with individuals with disorders of personality, mood, thought, and impulse control. In this new, 6-hour seminar, emphasis is placed on practical, evidence-based solutions for professionals in medical, dental, behavioral, and educational settings. Participants completing this program should be able to: 1. Describe how trauma and stress can alter the brain and impair social reasoning. 2. Identify diagnostic features of high-conflict individuals with selected disorders of personality, mood, anxiety and anger. 3. List several skills that health professionals can use to interact more effectively with high-conflict people. 4. List interventions that health professionals can apply to help protect and enhance their health when working with noxious people.

2 Please select the best answer for each question, and record your answers on the answer sheet at the end of the test. 1. Which of the following is not a characteristic of the toxic individual? A. A long history of interpersonal conflict B. Pathological childhood relationships C. Remarkable empathy for the feelings of others D. Aggressive energy 2. Common defenses seen with toxic individuals include all but which of the following? A. Splitting (e.g., black-or-white thinking) B. Projection C. Blaming others for problems they create D. All of the above are seen with toxic people. 3. Which of the following is true of the toxic individual? A. They trigger defensive reactions in others. B. They have an inordinate amount of aggressive energy. C. They are prone to be litigious. D. All of the above are true. 4. Which of the following is not a major role in a psychodrama? A. Mascot B. Hero C. Victim D. Villain 5. Which of the following is not a common presenting problem for toxic patients? A. Depression B. Anxiety C. Troubled relationships D. Substance abuse E. All of the above are common presenting problems. 6. Which of the following is not a common anger management issue with toxic individuals? A. They can be passive-aggressive. B. They can be too passive. C. They can be too aggressive. D. They can engage in overtly violent behavior, such as domestic violence. 7. Aggressive behavior can be fueled by which of the following? A. Stress B. Poor physical health, e.g., lousy diet, lack of exercise, chronic pain, etc. C. Atypical brain chemistry, e.g., low in serotonin D. Toxic relationship dynamics E. All of the above can fuel aggression. 8. Which of the following are common behavioral problems with toxic individuals? A. Boundary violations B. Problems managing anger and aggression C. Narcissistic behavior D. All of the above are behavioral problems with toxic individuals.

3 9. Boundary violations include all but which of the following? A. Physical abuse B. Emotional abuse C. Sexual abuse D. Office place bullying E. All of the above are boundary violations. 10. Self-abusive behavior: A. Rarely represents a suicide attempt. B. Is typically motivated by attention-seeking C. Is rarely a serious issue requiring formal intervention D. A only 11. Ignorance/Fear-based toxic behaviors include: A. Bigotry B. Prejudice C. Homophobia D. Sexism E. All of the above 12. Fear-based toxic behaviors include all but which of the following? A. Obsessive-compulsive behaviors, e.g., hoarding B. Excessive controlling behaviors, e.g., the boss who micro-manages his/her employees C. Aggressive behavior, especially in men D. All of the above are fear-based toxic behaviors. 13. Which of the following is not considered by researchers a form of self-mutilation? A. Eating disorders B. Cutting C. Burning (including branding ) D. Compulsive skin-picking E. Bone-breaking 14. Which of the following is not a cause for toxic behavior? A. Dysfunctional family dynamics B. One s cultural/ethnic background, per se C. Biological/Biogenetic factors D. Faulty learning history, e.g., poor role-models 15. Which of the following is not true of dysfunctional families? A. Parents may abuse or neglect their children. B. Boundaries can be blurred or violated. C. There is usually a family secret. D. All of the above are true for dysfunctional families. 16. Boundary violations: A. Can be blatant or subtle. B. Can involve physical, sexual, emotional or spiritual abuse. C. Are rarely an issue with dysfunctional families. D. A and B are true.

4 17. Biological factors which may impact the genesis of toxic behaviors include: A. Biogenetic influences, e.g., atypical brain chemistry, inherited psychiatric disorders, etc. B. Pre-birth or post-birth trauma to the central nervous system. C. Chronic or acute substance abuse D. Hormonal changes or imbalances E. All of the above 18. Learning factors that influence the development of toxic behavior would include which of the following? A. Reinforcement contingencies B. Poor or inadequate role models C. Profound lack of social intelligence D. All of the above E. A and B only 19. Toxic personality types would include all but which of the following? A. Borderline B. Narcissistic C. Anti-social (Sociopathic) D. Dependent 20. Common characteristics of personality-disordered individuals include: A. Adaptive inflexibility B. Vicious cycles C. Tenuous stability D. All of the above 21. Paranoid personalities: A. Are unduly mistrustful of others. B. Hold grudges and are prone to primitive acts of violence. C. Frequently seek treatment. D. All of the above are true. E. A and B are true. 22. Anti-social personalities: A. Tend to be compulsive liars. B. Are highly manipulative, even predatory. C. Have a high incidence of substance abuse. D. Rarely seek treatment voluntarily. E. All of the above are true. 23. Borderline personalities: A. Straddle the border between sanity and psychosis. B. Are typically triggered by real or perceived abandonment. C. Have primitive ego defense mechanisms, including splitting and projection of blame. D. Rarely seek professional treatment. E. A, B, and C are true. 24. Borderline personalities: A. Typically see themselves as villains B. Are most likely to act out when the clinician is focusing on behavioral change. C. Are typically not empathic/sensitive people. D. Rarely attract Sociopaths or Narcissists as domestic lovers/partners.

5 25. Histrionic personality disorder: A. Is diagnosed in women more frequently than men. B. Is diagnosed in men more frequently than women. C. Involves developmental fixation at an adolescent state of development. D. Can not be treated successfully with formal psychotherapy. 26. Treatable narcissists: A. Are driven by an emotional wound. B. Tend to be pretty self-absorbed. C. Have a high risk of developing addictive-compulsive behaviors. D. All of the above are true. 27. Malignant (untreatable) narcissists: A. Believe they are superior to others. B. Have fantasies of perfection and may be pre-occupied with envy. C. Have an insatiable need for power, prestige, wealth and attention. D. All of the above are true. E. Only A and B are true. 28. Compulsive/Perfectionistic personalities: A. Can come across as stiff, aloof and critical. B. Can be inordinately focused on details and miss the bigger picture. C. Are typically rigid and unyielding in conflict situations. D. Are prone to anxiety-based disorders, workaholism and other addictions. E. All of the above are true. 29. Passive-aggressive behavior: A. Is typically learned. B. Involves dealing with anger in a covert, sneaky manner. C. Can poison any relationship or work setting. D. Is ultimately self-defeating. E. All of the above are true. 30. Major mood disorders include all but: A. Major depression B. Obsessive-Compulsive Disorder C. Bipolar I Disorder D. Bipolar II Disorder 31. Anxiety-based disorders include which of the following? A. Generalized anxiety disorder B. Obsessive-Compulsive Disorder (OCD) C. Post-Traumatic Stress Disorder (PTSD) D. All of the above E. None of the above 32. Recommended dietary changes to reduce toxic brain chemistry include all but which of the following? A. A high-protein diet (unless medically contra-indicated) B. Reducing intake of white sugar and foods that contain white flour C. Eliminating foods that contain high-fructose corn syrup D. All of the above are strongly recommended.

6 33. Which of the following will not reduce toxic levels of cortisol in the brain? A. A heaping tablespoon of pure (virgin) coconut oil per day B. Regular aerobic exercise C. Daily meditation, prayer D. All of the above will reduce toxic levels of cortisol. 34. Toxic levels of cortisol can: A. Reduce levels of serotonin. B. Enlarge the Amygdala. C. Shrink the hippocampus. D. Greatly improve anger management. E. All but D are true. 35. An enlarged Amygdala can trigger which of the following? A. Enhanced empathy B. Enhanced impulse control C. Paranoia D. None of the above 36. A compromised hippocampus can lead to which of the following symptoms? A. Anhedonia, i.e., the inability to anticipate or experience pleasure B. An exaggerated flight-or-fight response C. Hoarding D. None of the above 37. A serotonin deficiency can cause which of the following symptoms? A. Problems with affect regulation, e.g., depression B. Anxiety-based disorders, e.g., OCD C. Problems with impulse control and judgment D. All of the above 38. Which of the following is not part of the D-E-S-K model? A. State your need or expectation. B. Describe the objectionable behavior. C. Express your feelings using an I statement. D. Do not be concerned about your tone of voice. 39. When addressing a toxic relationship, you should: A. Ask yourself what role you are playing in the toxic situation. B. Ask yourself what your feelings are about the other person s toxic behavior. C. Determine whether you have realistic expectations of the other person. D. Carefully weigh the pros and cons of confronting the toxic individual. E. All of the above 40. When dealing with interpersonal conflict, you should: A. Avoid it, if possible. B. Keep skid chains on your tongue. C. Err in the direction of being aggressive. D. None of the above.

7 41. When dealing with interpersonal conflict, you should: A. Wait at least 24 hours before confronting the other person with their behavior. B. Lead with an empathic or affirming statement. C. Use the D-E-S-K model to express your concern or feeling. D. All of the above. 42. When dealing with a narcissistic supervisor or boss, you should never: A. Lead with empathy. B. Confront them directly. C. Learn how to fly beneath their radar. D. Work at accepting the person while not liking their toxic behavior. 43. Appropriate treatment modalities for toxic individuals include all but which of the following? A. Individual, group and/or family therapy B. Skills training, e.g., anger management C. Electroconvulsive Therapy (E.C.T.) D. Targeted pharmacotherapy 44. Health professionals who treat toxic patients should: A. Be clear about your role and boundaries B. Set realistic treatment goals collaboratively with the patient. C. Strive to balance the technology of acceptance with the technology of change. D. Not allow themselves to be held hostage by any patient. E. All of the above. 45. Ethical reasons for terminating treatment pre-maturely include all but which of the following? A. Patient is not appropriate for treatment. B. Patient is clearly not benefitting from the treatment. C. Patient is having difficulty paying their co-payment in a timely fashion. D. Continued treatment could prove harmful to the patient. 46. Complaints to licensing boards and civil litigation can sometimes be avoided by: A. Avoiding any type of dual relationship with the patient, even post-termination. B. Hospitalizing patients who pose an imminent threat to themselves or others. C. Peer supervision, i.e., seeking the counsel of colleagues when working with toxic and other challenging patients. D. All of the above. 47. Malpractice litigation can be the result of: A. Mismanagement of countertransference. B. Not being clear and consistent about professional boundaries. C. Illegal or offensive improper billing practices. D. Terminating treatment with patients who are clearly not benefitting from your treatment. E. All but D. 48. To reduce toxicity in your life, you should: A. Detach (whenever possible) from toxic relationships. B. Set and enforce clear and consistent physical, emotional and sexual boundaries. C. Eat healthy and exercise aerobically regularly. D. Set realistic expectations for yourself and others. E. All of the above

8 Noxious People Please complete this form before December 1, 2014 (expiration date December 31, 2014) Send your fully completed form by: 1. scan and to 2. Mail: 788 Harlequin Ct., Los Banos, CA Fax: For customer service questions: Name (please print) Profession(s) License Number and State Your Address City St Zip Home Phone ( ) Home Fax ( ) Address Please send my results/certificate by (circle one) mail fax Please rate the degree to which each objective was met: A=excellent B=good C=average D=poor 1. Describe how trauma and stress can alter the brain and impair social reasoning. 2. Identify diagnostic features of high-conflict individuals with selected disorders of personality, mood, anxiety and anger. 3. List several skills that health professionals can use to interact more effectively with high-conflict people 4. List interventions that health professionals can apply to help protect and enhance their health when working with toxic people. Please help us improve the quality of our programs and rate the following: (A=strongly agree B=agree C=disagree D=strongly disagree) The author(s) was (were) knowledgeable The author(s) presented the material with clarity and effectiveness The author(s) utilized appropriate technology to support participant learning. The information was interesting The information provided in the program was current The learning materials for the program were relevant to my practice The learning materials for the program were appropriate to my education, experience, and licensure level The program was well organized The program delivery format and the use of technology (if applicable) was appropriate to support learning The level of difficulty (introductory, intermediate, advanced) was appropriate My questions or problems were addressed effectively and in a timely manner The learning assessment activities were appropriate The program met my personal objectives The program was free of commercial bias If you requested accommodations for a disability, please rate the experience. How long did it take for you to complete the program? Y N I would recommend the program to a colleague Comments, complaints, or feedback? Verification Statement My signature below confirms that I,, completed this program and post-test without assistance from anyone else. Signature Date / /