Building Internal Safety and Connection: Trauma-Informed Stabilization Treatment Level 2 Post-Test (Enduring)

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1. The Structural Dissociation model offers:*
- A scientific basis for TIST
- A conceptual roadmap for TIST
- A clinical approach
- A language for talking about parts
2. The term “structural dissociation” refers to:*
- A diagnostic system for classifying dissociative disorders
- An explanatory model for understanding trauma-related fragmentation
- A way of working with trauma
- Dissociative disorders
3. In the Structural Dissociation model, why are the parts labeled by their defensive responses?*
- a. Arbitrary classification system
- b. Parts of DID clients have names and identities
- c. Parts reflect survival responses rather than memory
- d. Parts remember events related to their survival defenses
4. Structural dissociation often manifests in:*
- Intractable internal conflicts
- Difficulty making good use of therapy
- Difficulty remembering what happened yesterday
- Stuckness in the therapy
5. “Structural dissociation” reflects:*
- The tendency to space out
- A way of dealing with memory
- The split or fragmented nature of the human brain
- A factitious symptom
6. TIST is organized around three brain activities. Which of the following is not essential in TIST?*
- A cognitive/conceptual framework for understanding traumatized parts
- The use of mindful observation and focus
- An experiential/emotionally connected way of working
- Skills for managing and containing the parts
7. The ability to tolerate feelings and impulses is directly related to:*
- Early secure attachment relationships
- How strict vs. permissive our parents were
- Traumatic experience
- Early experiences of acceptance vs. rejection
8. Traumatic experiences in childhood cause long-term*
- Dysregulated emotions and nervous system
- Inability to trust and difficulty feeling safe in connection
- Low self-esteem
- Chronic fear
9. To build trusting relationships between the adult client and the parts requires:*
- Reassuring them that they are safe
- Carrying on a stable life
- Communicating understanding and empathy to the parts
- Disconnection and numbing
10. In order to ‘get’ the parts and interpret their emotions and impulses,*
- The client has to blend with them
- The client has to blend with them
- The client has to understand them as having their own separate perspectives
- The client has to name them
11. In order to “hear the voices” of the parts, client and therapist have to listen for:*
- Internal conflicts
- Behavior or beliefs that block change and growth
- Impulsive behavior
- Signs of inner conflict, blocking or resistance, and/or impulses
12. A “parts whisperer” approaches parts by:*
- Asking them to tell what what happened
- Trying to understand their world, language, and point of view
- Providing play therapy
- Talking baby talk
13. Trust between the adult client and the parts must be built by:*
- Treating the parts with dignity and respect
- Trying to integrate them
- Feeling their pain
- Stabilizing their adult lives
14. The therapist’s role as a ‘parts whisperer’ is to:*
- Model compassion and empathy
- Gain the trust of the parts
- To keep the client focused and empathically connected to the parts
- Elicit increased communication from parts
15. Which of the following is not one of the ‘law of dissociation’?*
- ‘A part is just a part’
- ‘The goal of treatment is integration’
- ‘The system was designed for survival, not destruction’ empathically connected to the parts
- ‘The therapist is the therapist for all the parts”
16. Being a ‘therapist for all the parts’ means that:*
- We treat the client like a family with many family members
- Hold memories of events that they can narrate
- Are repositories of memories from certain ages
- Are a metaphorical concept without merit
17. “Advocating” for parts is:*
- What we ask the client to do
- A therapeutic technique used by the therapist
- A legal term
- Reinforcement of unsafe behavior
18. When the therapist advocates for a protector part,*
- It is confusing for the client
- It is a paradoxical intervention
- It is a means of building a trusting relationship with that part
- It undermines deepening the work
19. “Advocating” for a part can also be a way of:*
- Increasing client curiosity
- Increasing the client’s empathy for the part
- Increasing internal awareness of the system
- Increasing curiosity, internal awareness and empathy
20. Consistent or relentless reframing of distressing and unsafe behavior as parts results in:*
- Challenging habitual actions and reactions
- Facilitating a more mindful relationship to distress and impulsivity
- Facilitating awareness by challenging habitual patterns
- Decreasing tendencies to intellectualize
21. Why do therapists develop adversarial relationships to protector parts?*
- Fear of unsafe behavior
- Frustration
- Wish to help client connect to emotions
- Misunderstanding of the role of protectors
22. Protector parts include which of the following:*
- Depressed parts
- Suicidal parts
- Flirtatious parts
- Sad parts
23. Internal critics and judgmental parts are:*
- Perpetrator introjects
- Anxious parts
- Protector parts
- Hostile parts
24. Spaciness and disconnection from emotion and sensation are caused by:*
- Dissociative alteration of consciousness
- Protector parts guarding against emotional vulnerability
- Parasympathetic arousal
- Attempt to avoid affect
25. “Resourcing the defense” refers to which of the following interventions:*
- Reframing the protector as having positive intentions
- Helping clients capitalize on the resources of the protector part
- A paradoxical technique to reduce unsafe behavior
- A way of increasing self-empathy
26. Validating the protector part’s perspective is best achieved by:*
- Empathizing with the protector’s woundedness
- Validating the protector’s contribution to the client’s survival
- Asking the part to connect to childhood memory
- Helping the client to unblend from the protector part
27. The best way to address the protector parts’ attempts to control the therapy is by:*
- To discuss it as a transference issue
- Having strong therapeutic boundaries
- Giving the protectors control over the degree of client disclosure and vulnerability
- Increasing the client’s ability to stand up to them
28. The issue of trust in the treatment is best understood as:*
- An issue of the protector parts’ trust or confidence in the client
- Emotional memory of the fear of trust
- A post-traumatic symptoms
- A transference issue
29. Trust between client and protector parts is built through which of the following activities?*
- Client empathy for the protectors
- Small negotiated changes in how client and protectors handle emotional stress
- Internal communication
- Internal communication resulting in negotiating ‘tests’ of the client’s ability to be self-protective
30. Ways in which wounded parts try to get around the defensive efforts of protectors:*
- Flooding of emotion
- Intrusive thoughts, images, emotions and body sensations
- Regressive behavior
- Unsafe behavior
31. The NUCA protocol describes which of the following:*
- Notice, Unblend, be Curious, Affirm or Validate
- Name, Unblend, Caution, Advocate
- Notice, Unblend, evoke Compassion, Affirm
- Notice, Name, Unblend, Compassion, Advocate
32. With suicidal and self-destructive parts, it is essential to help the client:*
- Engage in safer behavior
- Abstain from self-harm
- Avoid blending with these parts
- Experience them as parts and avoid blending with them
33. In TIST, the following is not an immediate problem:*
- Trust
- Connection to emotion and sensation
- The ability to be self-aware
- Understanding the psychoeducation
34. Which is the more important priority in TIST?*
- Therapist empathic connection to the parts
- Therapist empathic connection to the client
- Client’s empathic connection to the parts
- Parts’ empathic connection to the client
35. Unsafe, addictive and eating disordered behavior is always addressed as:*
- A safety issue
- An issue between the client and the parts
- A behavioral issue
- An issue between the client and therapist
36. In TIST, all distressing feelings and impulsive behavior are understood as:*
- The result of blending with parts
- Post-traumatic reactions
- Requiring regulation skills
- Triggering
37. Homework and repetition are not a priority in TIST:*
- True
- False
38. The “Going On with Normal Life Part” reflects:*
- A false self
- An adapted child part
- An instinctive impulse to ‘keep on keeping on’
- A set of resources
39. In Structural Dissociation theory, the client’s current life functioning is considered:*
- Irrelevant to the treatment
- A false self
- A barometer indicating stability
- A reflection of the strengths of the client’s “going on with normal life self”
40. The Going On with Normal Life Part has access to which parts of the brain?*
- The emotional brain or limbic system
- The prefrontal cortex
- The brainstem and cerebellum
- The temporal lobes
41. Accessing the Normal Life part is best achieved by:*
- Helping clients acknowledge their strengths and competencies
- Increasing self-esteem
- Emphasis on cultivating their ability to notice or observe
- Skill-building
42. “Highjacking” is a trauma-related term describing what phenomenon?*
- The result of triggering (i.e., prefrontal inhibition, limbic activation)
- Acting out behavior
- Distorted cognitions
- A dysregulated nervous system
43. Greater difficulty functioning in daily life and frequent crises, hospitalizations, or need for emergency services is an indicator that:*
- The client needs to learn more skills for stabilization and self-management
- The parts have “highjacked” the Going On with Normal Life Self
- The client is manipulative and attention-seeking
- The client has a personality disorder
44. One of the major challenges for the therapist working with fragmented individuals is:*
- Keeping in mind that the client is a whole person and has a fragmented self
- Keeping in mind that the client is a whole person even if he perceives himself as fragmented
- Keeping in mind that the client is fragmented even if he perceives himself as a whole person
- Avoiding the use of the word “part”
45. In therapy with trauma clients, it is important to:*
- Recognize regressive behavior as a sign of child parts emerging in the treatment
- Work individually with each traumatized part
- Treat the client as if he or she were not fragmented
- Teach the client to play or read aloud to child parts
46. In treating fragmentation and self-alienation, the first step is:*
- Learning to mindfully notice the indications of parts
- Developing the capacity to care for the parts
- Helping the client to tolerate the parts’ memories
- Accept a diagnosis of DID
47. When therapists notice signs of child parts or protectors emerging in therapy,*
- They should continue to talk to the adult client
- They should acknowledge what they notice
- They should act as if nothing has changed
- They should attempt to get the adult client back
48. One of the challenges of trauma treatment for the therapist is:*
- Being dysregulated by dysregulated and dissociative clients
- Managing high-risk behavior
- Tolerating stuckness and resistance
- Exposure to details of traumatic memory
49. In TIST, therapists are encouraged to:*
- Verbalize their own internal process
- Regulate their autonomic arousal by relaxing the body
- Use their somatic resources
- Undertake their own therapy
50. Therapists are also encouraged to:*
- Deepen the work despite client resistance
- Make sure the client learns the TIST skills
- Slow the pace and take ‘baby steps’
- Focus on client self-regulation
51. In work with fragmented clients, therapists must be careful to:*
- Avoid using the language of parts
- Avoid assuming that what is being expressed represents the whole of the client’s feelings/point of view
- Use only the client’s given name, never the names of the parts
- Treat the client as if s/he were a whole unfragmented person
52. What is the defining symptom that differentiates DID from other DDs?*
- Two or more parts can independently act outside of the client’s consciousness
- The parts have names
- Amnesia for the trauma
- Switching
53. In DID clients, the parts do not know that they share:*
- The same body
- The same traumatic past
- The same environment
- A new life beyond trauma
54. When triggers activate the parts’ hyper- and hypoarousal responses,*
- The whole body is activated
- The prefrontal cortex is inhibited
- Hijacking of the Normal Life occurs
- Prefrontal cortical ability is inhibited, shutting down the Normal Life part
55. The therapist can stimulate the Normal Life part of clients by:*
- Talking about the day to day issues in their lives
- By asking them to notice what is happening in the moment
- By helping the client connect to their resources without asking them to acknowledge any positive quality
- By mindful observing, focusing on daily life and using the client’s resources
56. ‘Co-consciousness’ refers to:*
- The ability of clients and parts to be simultaneously conscious of moment-to-moment experience
- Continuity of consciousness across time
- The ability of client and parts to communicate
- Co-regulation
57. Parts communicate with the client and each other via:*
- Thoughts and emotions
- Dreams, memories, images
- Impulses and actions
- Thoughts, feelings, impulses, behavior and dreams or fantasies
58. Hearing voices is a sign of:*
- Psychosis
- Auditory hallucinations
- Communication from parts
- Attention-seeking
59. Parts hold the memories of the trauma*
- That the client has forgotten
- Implicitly as emotional, perceptual, somatic, and behavioral memories
- As seen through the lens of their survival strategies
- Implicitly and differently depending on their survival responses
60. Fragmented and dissociated parts:*
- Hold whole narratives of past events
- May hold different versions of the same event
- Are imaginary
- Experience the past as not yet over and themselves as still in danger
61. With perceptions distorted by the trauma, parts may have no awareness of the client’s present reality*
- True
- False
62. “Switching” refers to:*
- Changes in decision-making
- Substituting one part for another
- Alterations of consciousness in which client ‘becomes’ a part
- Losing time
63. In DID clients, parts can ‘switch’ and then:*
- Come out in therapy or contact the therapist between sessions
- The client’s demeanor changes
- The client spaces out
- The therapist gets confused
64. Suicidal, self-destructive, and addictive behavior reflect:*
- Attention-seeking behavior
- Pleasure- or punishment-seeking behavior
- Activity of the Fight and Flight parts
- The wish to die
65. Parts driven by the ‘attach for survival’ or ‘cry for help’ responses are identifiable because of their:*
- Their suicidal tendencies
- Their neediness and dependent behavior
- Impulsive attention-seeking
- Hopeless and passivity
66. Shame, hopelessness and self-loathing are all common emotional reactions of which part of the personality?*
- Freeze
- Fight
- Freeze
- Submit
67. Indications of the Fight part include which of the following?*
- Devaluing the therapist
- Masochism
- Avoidance of close relationships
- Caretaking
69. Denial of the trauma or minimizing what happened is associated with which part?*
- Attach
- Submit
- Fight
- Going on with Normal Life self
68. The Flight part is associated with which of the following symptoms?*
- Intolerance of enclosed spaces
- Substance abuse and eating disorders
- Long-term relationships
- Love for movement and dance
69. Denial of the trauma or minimizing what happened is associated with which part?*
- Attach
- Submit
- Fight
- Going on with Normal Life self
70. Client instability or unsafe behavior reflects:*
- Attention-seeking behavior
- Internal conflicts between parts driven by different survival strategies
- Signs of a personality disorder diagnosis
- Self-destructive tendencies
71. In working with DID clients, effective treatment hinges on:*
- Facilitating collaborative relationships between the Normal Life Self and traumatized younger parts
- Integrating parts into one homogenized identity
- Teaching clients to understand all the different reactions as ‘mine’
- Managing the self-destructive and regressive behavior of the parts
72. Attempts by parts to have a ‘behind the back’ private relationship with the therapist*
- Should be encouraged
- Should be discouraged
- Is a normal part of DID treatment
- Is a common part of DID treatment but should be discouraged
73. In DID treatment, it is important that the client re-experience the traumatic events that are known to the parts and accept them as ‘mine’*
- True
- False
74. Sadistic, malevolent abuse is distinguished by:*
- The induction of anticipatory fear/terror
- The induction of a sense of complicity
- The extreme events
- Induction of a sense of complicity and anticipatory terror
75. “Programming” refers to:*
- Hypnotic induction of certain beliefs and warnings useful to the perpetrators
- Cognitive schemas taught by the perpetrators
- Procedurally learned survival behaviors
- Procedurally learned survival beliefs
76. Cult and ritual abuse practices include:*
- Forced participation in abuse of others
- Staged rituals of blood transfusions, births, and marriages to Satan
- Post-hypnotic warnings against disclosure
- Forced participation, staged rituals and warnings against disclosure
77. The effects of human trafficking and cult abuse on the autonomic nervous system are:*
- The same as with other forms of trauma
- More extreme dysregulation and prolonged hyperarousal
- Increased parasympathetic arousal
- Increased impulsivity
78. In addition to the structurally dissociated survival-related parts, there may also be:*
- Parts identified with the cult or group
- Parts hypnotically created by the cult or group
- Guerilla fighter parts
- Parts identified with the group and hypnotically created parts
79. Therapists often experience countertransference responses of:*
- Anxiety about the client’s safety
- Anxiety about their own safety
- Fear and a feeling of responsibility for the client
- A wish to flee (ie, refer the client to another therapist)
80. Focus on memory with survivors of sadistic malevolent trauma is:*
- Complicated by the extreme nature of the events
- The potential de-stabilization effects
- The fear of disclosure
- Fear of disclosure coupled with the dysregulating effects of remembering extreme events
81. Client internet research into ritual abuse or human trafficking may result in:*
- Client preoccupation with the abuse
- Obtaining dysregulating or more extreme information
- Being cyber-stalked
- Stimulating increased fears or dysregulation
82. Treatment of extreme sadistic abuse should focus on:*
- Neuroplastic change of procedural and programmed responses
- Overcoming autonomic dysregulation
- De-programming
- Disclosure of memory
83. Working with the body rather than the events allows the client to:*
- Avoid the abuse memories
- Dis-identify with the symptoms
- Discover the resources that enabled parts to survive
- Overcome dysregulation
84. Emphasis on the parts working as a team results in:*
- Less dependence on the therapist
- Giving responsibility for safety to the system
- Facilitates co-consciousness and integration
- The system learning to regulate itself rather than relying on the therapist
85. Resolving trauma requires:*
- An autonomic nervous system capable of regulating stress and emotion within a window of tolerance.
- Retrieving the memories of what happened
- Feeling loved by the therapist
- Processing the traumatic memories
86. Modern theories and neuroscience emphasize the following aspect of trauma treatment:*
- Repairing the effects of the trauma
- Challenging negative cognitive schemas
- The therapeutic relationship as the healing agent
- Exposure to memory
87. Memory processing with DID or other fragmented clients is more effective when:*
- It includes processing each part’s memory for individual events
- The focus is on resolving the effects of what happened on the parts
- It includes confrontation of the family and perpetrator
- It includes cognitive re-framing
88. In memory processing work with fragmented clients, the focus is on:*
- Making sure the whole system is in agreement
- The child part(s) connected to the memory
- Making sure that the rememberer is the child part and the witness is the adult client
- Regulating autonomic arousal
89. The first step in developing internal attachment to one’s parts is:*
- Giving the parts names and identities
- Self-compassion
- Negotiation of safety contracts with destructive parts
- Overcoming the tendency to distance from them and cultivating empathy instead
90. “Rupture and repair” refers to:*
- Parental soothing of infant distress
- Behavior of abusive parents
- Repair of therapeutic ruptures
- Secure attachment
91. The rupture and repair model for parts assumes:*
- That the therapist will offer reparative experiences
- That clients recognize distressing emotions as communications from parts
- That clients recognize ‘ruptures’ as parts and offer them ‘repair’
- That clients hear the parts’ memories and accept them
92. “Missing experience” is a term that describes:*
- The impact of neglect
- The impact of the trauma
- The impact of depriving a child of safe attachment experiences
- The impact of being shamed and humiliated
93. The Attach part needs the missing experience of:*
- Safety from abandonment
- Feeling loved and valued
- Comfort and reassurance
- Safety from abandonment and feeling special
94. The Fight part needs the missing experience of:*
- Effective aggression
- Being given control and respect
- Being given comfort
- Being given reassurance
95. The Freeze or fearful part needs the missing experience of:*
- Protection
- Safety
- Comfort
- Protection and safety
96. The Submit part needs the missing experience of:*
- Safety in setting boundaries
- Ability to say No
- Pride instead of shame
- Boundaries, the ability to say No, pride
97. Visualization techniques represent another vehicle for the Normal Life self to:*
- Disclose traumatic memories
- Offer comfort and safety
- Develop resources for managing impulsivity
- Develop a ‘safe place’
98. Visualizing or imagining an experience we have never had:*
- Is a hypnotic technique
- Is a form of denial
- Is a vehicle for self-soothing
- Can be used to evoke new physical and emotional responses as if we were experiencing them now.
99. Positive experiences of emotional attachment and tenderness toward parts can be transformative if:*
- The client does not forget them
- They are solidified through repetition
- They open up the client emotionally
- The client feels them somatically and emotionally
100. The key to trauma resolution in fragmented individuals is:*
- Understanding that the parts’ implicit memories are what keeps the past alive
- The ability to feel one’s self as one whole person
- Ability to acknowledge the severity of the trauma
- Ability to talk about what happened within the Window of Tolerance
101. In order to experience trauma as “resolved” or “over,” the client’s body first needs to:*
- Be calm and focused
- Experience a felt sense of safety
- Experience a sense of threat
- No longer react to remembered events
102. Trauma resolution includes an internal sense of safety which is fostered through:*
- Empathic connections between a wise Normal Life adult and wounded child part
- Completion of undischarged bodily responses
- Transformed beliefs about one’s self and the world
- The ability to defend one’s self
103. Though the symptoms and the parts reflect the legacy of the past, treatment must prioritize:*
- Attention to traumatic events and memories
- Attention to the parts’ present experience
- Attention to increasing functioning and self-esteem
- Attention to the therapeutic transference
104. Self-compassion is considered:*
- As essential to trauma recovery as mindfulness
- Too challenging for survivors of trauma
- Possible only when the traumatic memories have been processed
- A ‘new age’ idea but not a therapeutic intervention
105. “Healing” in trauma treatment means:*
- To help clients get their feelings and memories “up and out”
- To stabilize and resume normal life
- To complete the processing of traumatic memories
- To accept, forgive and welcome all parts of the self
106. “Internal attachment” is a term that refers to:*
- The relationship we have to our young, emotional ‘selves’
- The biological drive to attach to our children
- Introjected representations of our parents
- How we feel about ourselves
107. Self-acceptance is a reflection of:*
- Good self-esteem
- Internal attachment relationships to one’s parts
- Decreased shame and self-loathing
- The development of self-compassion
108. “Earned secure attachment” is the result of:*
- Thorough trauma processing
- Integration of past and present
- Secure attachment between parts and client
- Good relationships

Building Internal Safety and Connection: Trauma-Informed Stabilization Treatment Level 2 Post-Test (Enduring)

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