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Assumption. The correct answer choice is (D).

The psychotherapist's argument begins from two premises: (1) that the troubles patients use psychotherapy for do not have purely internal causes, and (2) that one of the external causes of patients' troubles is their relationships with other people.

The psychotherapist then concludes that psychotherapists must focus on creating positive change in patients' relationships with other people to help them heal.

The simple, but unstated, connection between premises and conclusion is that patient healing in psychotherapy requires a focus on external, not just internal, causes (i.e. positive change in relationships). This is our prephrase, a classic Supporter Assumption (filling the gap between premises and conclusion).

Answer choice (A): Answer choice A is out of the scope of the argument. While the argument does presume a need for positive change in relationships, it never tells us how that positive change must be created. Thus, when answer choice A hinges change in relationships on the necessity of "patients focus[ing] on other people's troubles," it goes beyond what the argument discusses or assumes.

Answer choice (B): The argument never stakes out a position on how often, or even whether, the focus on relationships will fail, so it too goes beyond the scope of the argument. Moreover, by referring merely to the psychotherapist helping people "change their relationships," without specifying positive change, the answer choice is too broad. We know the author thinks positive change in relationships is necessary, but we do not know what the author thinks will be the result of every kind of relationship change (positive, negative, or neutral).

Answer choice (C): There are two problems with answer choice C. Like answer choice B, it is too broad (and so out of scope of the argument) when it refers to patients who "change their relationships." The specific change the stimulus requires is positive change, so once again the author does not stake out a position on the result of every kind of relationship change (positive, negative, or neutral). Further, answer choice C is a Mistaken Reversal of the conditional logic of the conclusion. The conclusion makes positive change in relationships necessary for healing (it "must" happen). Answer choice C states that change in relationships is sufficient for healing ("patients who" is a sufficient condition indicator).

Answer choice (D): This is the correct answer choice. Answer choice D fits our prephrase, in which we said that patient healing requires a focus on external causes, meaning no psychotherapist can help patients heal by focusing solely on internal causes.

Answer choice (E): Answer choice E is out of scope of the argument, because the stimulus is about the internal/external causes of patient troubles, whereas answer choice E is about whether the trouble itself is internal. Answer choice E is also out of scope when it refers to "the relief they seek." The argument is not about giving patients the relief they personally seek, rather it is about helping them heal. Even if you read answer choice E to be referring to the causes of patients' troubles and healing more generally, it is still incorrect because it directly contradicts the argument. The argument makes clear that focusing on internal causes is not enough for healing.
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