MFT Exam Study Questions

According to general systems theory, positive feedback: Select one: a. increases the likelihood that a behavior will occur again b. promotes self-differentiation c. increases deviation from a balanced state d. maintains homeostasis

According to general systems theory, positive feedback upsets homeostasis and increases deviation from a steady state. Answer C is CORRECT: This is correct; see above. Answer A is incorrect: This choice would have misled you if you confused positive feedback and positive reinforcement, a behavioral technique used to increase the occurrence of a behavior. Remember to read carefully when taking the exam. Answer B is incorrect: Promoting the change brought about by positive feedback and increasing differentiation are both goals of some family therapists, however, general systems theory does not specifically predict that positive feedback will "promote differentiation." The concept of increasing self-differentiation is a part of Bowen's extended family systems therapy. Answer D is incorrect: This is the opposite of what is true. Systems theorists would say that negative, rather than positive, feedback is used by families to maintain homeostasis. The correct answer is: increases deviation from a balanced state

Alex, age 32, has been a "hermit" all his life. He lives with his family, spends most of his time alone in his room listening to music, and says he never feels particularly happy or unhappy. Six months ago, Alex was diagnosed with Brief Psychotic Disorder. Alex has never had a close relationship and says he does not mind. His symptoms are most suggestive of which of the following? Select one: a. Schizophreniform Disorder. b. Major Depressive Disorder. c. Schizoaffective Disorder. d. Schizoid Personality Disorder.

Alex's symptoms are not explained by Brief Psychotic Disorder or other psychotic disorder and suggest that another diagnosis is appropriate.Answer D is correct: Alex's life-long isolation, indifference to social relationships, and lack of strong emotions are consistent with a diagnosis of Schizoid Personality Disorder.Answer A is incorrect: Schizophreniform Disorder is characterized by symptoms similar to those associated with Schizophrenia except that their duration is one month to less than six months. Because Alex was diagnosed with Brief Psychotic Disorder, we know that the duration of his psychotic symptoms did not exceed one month. Moreover, he is not currently experiencing psychotic symptoms.Answer B is incorrect: You can rule out Major Depressive Disorder since there are no obvious symptoms of a major depressive episode. In addition, Alex's symptoms have been life-long.Answer C is incorrect: Schizoaffective Disorder requires a combination of psychotic symptoms and mood episodes. The correct answer is: Schizoid Personality Disorder.

You are doing play therapy with a child who has recently lost his house in an earthquake. He has been displaying a variety of anxiety symptoms, and his use of the toys suggests a metaphor for his symptomatic anxious behavior. What should you do? Select one: a. Play with the child, trying to change the metaphor so that he does not reenact his trauma. b. Introduce a new metaphor. c. Stay with the metaphor until the child play spontaneously changes. d. Introduce new coping skills.

Although each group is unique, certain traits are typical of most groups. Answer A is CORRECT: In the beginning stages of therapy, group members haven't yet started to relate to one another or to form social relationships and, therefore, they typically communicate only with the therapist, as if the other group members weren't present. During this initial stage, the therapist should be prepared to play an active role. Answer B is incorrect: See explanation for answer "a." Answer C is incorrect: This reaction may occur later in the development of the group, if group members displace angry feelings onto the group leader. Answer D is incorrect: This tends to occur later in the development of the group. The correct answer is: Play with the child, trying to change the metaphor so that he does not reenact his trauma.

John, a housepainter, aged 30, is permanently disabled due to an injury on the job six months ago. He can do desk work but nothing involving physical labor. He comes to counseling because he is depressed and anxious about how he will support his wife and two children. He is suing the company who employed him, claiming the equipment they provided was defective and caused him to fall. John's lawyer has encouraged him to seek counseling. Your initial consideration when deciding whether to accept John as a client is: Select one: a. whether John's symptoms are relational in context b. whether John's symptoms are relatively minor c. whether John will give you permission to consult with his doctors and lawyers d. whether you have experience dealing with this type of client

Although it is not clear from the information given in the question, the correct answer is based on a legal obligation.Answer A is correct: Scope of practice is always an important initial consideration and is determined by whether or not there are relationship issues in the case. Therefore, this is the best answer.Answer B is incorrect: Marriage and family therapists are not restricted to treating "minor" symptoms. If you are qualified and competent to treat a case, you may do so even if the symptoms are not minor as long as the focus of treatment is on interpersonal issues.Answer C is incorrect: Although this might be important, it isn't your primary consideration. You might choose to treat him even if you can't talk to his lawyers, but you cannot treat him if his case is outside your scope of practice.Answer D is incorrect: If you have no experience with this type of client, this would be a good reason not to take the case. However, you would first determine whether a case is one a marriage and family therapist generally should handle and, if it is, then consider whether you have adequate training and experience. Since you are asked for your initial consideration, "a" is a better answer. The correct answer is: whether John's symptoms are relational in context

The therapist has been seeing a client who has borderline personality syndrome for three months, and is asked by the court to provide an update as to the client's progress. How would the therapist gauge whether the client has made progress in therapy? Select one: a. By the degree to which the client has incorporated the therapist's holding capacity to protect herself b. By whether the negative transferences on the therapist have transformed into positive transference c. By the type of defense mechanisms the client is currently using as compared to before d. By administering an MMPI pre-therapy and as a mid-therapy measurement

Answer A is CORRECT: If this is long-term Object Relations therapy, one of the goals would be for the client to introject the therapist's ability to self-manage and self-sooth (holding capacity). The client may not have introjected much of this ability from the therapist at three months, but could have, and this would be a good gauge of progress. In laymen's terms, you might translate this answer into something like, "The degree to which the client has begun to manage her own emotions and keep herself safe, by using the relationship with the therapist."Answer B is incorrect: If this is long-term therapy, working through transferences would be appropriate, however we don't know whether this is long or short term therapy. Also, transforming negative into positive transference isn't really the goal of long-term psychodynamic therapy.Answer C is incorrect: This might be appropriate over a longer term therapy. One would not expect the defensive structure of a client with borderline personality disorder to change very much in three months.Answer D is incorrect: The MMPI would probably not show a lot of change in such a short time. The correct answer is: By the degree to which the client has incorporated the therapist's holding capacity to protect herself

You are referred a client who mutilates animals, has flat affect, and appears to be very uneasy in the session. What would be your initial course of action with this client? Select one: a. Get information releases, do a substance abuse evaluation, assess for suicide risk. b. Do a substance abuse evaluation, assess for suicide risk, refer to a group. c. Inform the client about the limits of confidentiality and have him involuntarily hospitalized. d. Try to establish rapport with the client so that he will speak more freely.

Answer A is Correct: The information in the question suggests that the man may pose a danger to himself and/or others. Therefore, only one of the four choices is appropriate as the initial course of action. When dealing with a client who appears dangerous, your first order of business is to assess the level of danger. Contacting the other health professionals that this man has seen (after obtaining the necessary information releases), doing a substance abuse evaluation, and assessing for suicide risk are all methods of assessing a client's level of danger to self or others.Answer Bis incorrect: Eliminate this right away, since referral to a group seems inappropriate at this time. This referral would not address or take into account the issue that the man may pose a danger to himself or others. Moreover, if this man is uneasy with you, he is likely to be uneasy in a group setting as well.Answer C is incorrect: Arranging to have the man involuntarily hospitalized would be an option if he presented a clear and immediate danger to himself or others due to a mental disorder. At this point, you only suspect that he may be dangerous. After further assessment, you may determine that this course of action is necessary.Answer D is incorrect: Establishing rapport would be helpful in the long-run but this answer doesn't address the emergency issue of potential danger to self or others. The correct answer is: Get information releases, do a substance abuse evaluation, assess for suicide risk.

Your client is a college student. He is very angry at his girlfriend for cheating on him and has threatened to hurt her. He has access to a gun. Both he and his girlfriend are from out of state and live in the same dormitory at the local college. You believe that the client's threat is serious. Whom do you warn? Select one: a. The girlfriend's roommate. b. The client's roommate. c. The girlfriend's parents. d. The client's parents.

Answer A is Correct: This question, like some on the exam, doesn't offer you a "perfect" or clearly correct answer; therefore, you had to choose from among four poor alternatives. "A" is the best answer offered. In this case, you have a "reasonably identifiable victim" (the girlfriend) and believe that the threat is "serious" (i.e., imminent). Therefore, your duty to protect has clearly arisen; however, none of the choices describes directly warning the intended victim or notifying a law enforcement agency. Therefore, you're left with using "common sense" to decide which of the choices best describes a "reasonably necessary step" or, in other words, is most likely to result in a communication of the threat to the victim so that she can be protected from it. Of the options available, telling the girlfriend's roommate is probably the best way of getting word to her that she is in danger. Answer B is incorrect: This is not the most direct way of getting word to the girlfriend that she is in danger. Answer C is incorrect: The question suggests that the girlfriend lives far away from her parents, so this is less likely than "A" to be an effective means of protecting her. Answer D is incorrect: This is not a reasonable way of getting word to the girlfriend that she is in danger. The correct answer is: The girlfriend's roommate.

Jiro, a 47-year-old Japanese-American, was initially referred to you by his medical doctor for work-related stress. Jiro works in the family restaurant, where he and his younger brother are both chefs working under their father. A few months pass, and Jiro has made significant progress. He tells you he is ready to end therapy, so you begin termination. Two weeks into the process, his younger brother leaves to open his own restaurant. You ask Jiro for his reaction and he replies, "In Japanese tradition, the eldest son succeeds his father. It's only natural that I stay until such time." You should: Select one: a. Proceed with termination as planned. b. Ask Jiro to bring in his father and younger brother for a family session. c. Extend termination several weeks and explore more about Japanese traditions with Jiro. d. Ask Jiro why his brother gets to leave the family business and he does not.

Answer A is correct: All the clues point to termination as planned: your client has made significant process and he tells you that he is ready to end therapy. The fact that his brother's actions have induced a decision for his own life is culturally relevant but not a clinical reason to avoid termination. The correct answer is: Proceed with termination as planned.

You have been treating a single father of four children for the last six months and have been planning for termination. He comes into session very distraught and tells you that his mortgage cannot be refinanced, and the bank is starting foreclosure proceedings on his home. How BEST would you proceed? Select one: a. Renegotiate the treatment contract. b. Continue with termination as planned. c. Refer to Consumer Credit Counseling. d. Postpone termination for an additional month.

Answer A is correct: Renegotiating the treatment contract changes the treatment process from termination to addressing the new psychosocial stressor. An even better response would have been to ask the client if he wanted to continue treatment or not. Continuing with termination ignores the client's new and very significant psychosocial stressor (B). Referring to Consumer Credit Counseling does not address the client's emotional reactions (C). Postponing termination for an additional month does not address the need to renegotiate the terms of the treatment contract, as it only focuses on a time frame of treatment (D). The correct answer is: Renegotiate the treatment contract. Question 98

The Lawsons came to therapy because their 17-year-old daughter, Marlene, was exhibiting anorexic symptoms. Three months later, Marlene's weight is within normal range and the parents are operating effectively as a team. Which of the following termination criteria would NOT be significant for a structural family therapist? Select one: a. The presenting problem has been resolved. b. The family has learned new coping skills. c. There are permeable boundaries between the subsystems. d. The marital dyad has been realigned.

Answer A is correct: Resolution of the presenting problem is more associated with the goals of strategic therapy than structural therapy. Although the presenting problem will likely be resolved by the end of therapy, structural therapists are more concerned with creating second order change, which is a change in the system, rather than simply resolving the presenting problem. The development of greater flexibility in adapting to new situations—otherwise known as better coping skills—is an important goal of structural family therapy (B). Structural family therapy concerns itself with creating flexible and permeable boundaries (C). Restructuring the marital dyad would be a goal of structural family therapy (D). The correct answer is: The presenting problem has been resolved.

Your client is an 11-year-old boy who has a history of behavioral problems. At school, the boy disturbs his classmates whenever the teacher asks the students to work independently on assignments in the classroom. He talks, makes noises, and throws paper wads and pencils to disrupt the other students and avoid doing his own work. He is easily annoyed and often loses his temper. The most likely DSM-5 diagnosis for this boy is which of the following? Select one: a. Oppositional Defiant Disorder b. ADHD c. Conduct Disorder d. Intermittent Explosive Disorder

Answer A is correct: Although the information provided is too limited to make a firm diagnosis (e.g., you don't know the duration of the boy's symptoms or how he behaves at home and in other settings), Oppositional Defiant Disorder (ODD) is the most likely diagnosis. The boy has a history of behavioral problems and appears to be deliberately annoying others and resisting or defying his teacher's requests, and he is easily annoyed and often loses his temper. As described in the DSM-5, ODD is characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness. The boy's symptoms do not meet the criteria for inattention or hyperactivity-impulsivity required for a diagnosis of ADHD and aren't sufficiently severe for a diagnosis of Conduct Disorder or Intermittent Explosive Disorder. The correct answer is: Oppositional Defiant Disorder

In an initial session with a client, one partner becomes aggressive and angry and the other becomes silent and shrugs when questions are directed to him. The aggressive partner says tells you, "sure we fight, but he misunderstands why I get violent. It's because I care." Midway through the session, the aggressive partner says, "we will talk about this more when we get home, this is not the reason we came here". What is the therapist's BEST intervention at this point? Select one: a.Separate the couple for the remainder of the session. b.Suggest that they end the session now and make a referral for individual therapy before couple's work can proceed. c.Join with the aggressive partner and what he would prefer to talk about to diffuse the situation. d.Point out that things that escalate to violence can interfere with their goals and would be a good topic to cover in session.

Answer A is correct: Separating the couple will allow the therapist to attempt to de-escalate the aggressive member of the couple and create a safety plan with the individual that may be in danger. Answer B is incorrect: It is true that this couple is not ready for couple's therapy if there is a possibility of violence following a session and individual therapist referrals would be the next step, after responding to the possible violence that could happen that day. Answer C is incorrect: Joining with the aggressive partner and seeing what he wants to talk about ignores the possibility of violence occurring and could endanger the abused member of the couple. Answer D is incorrect: Pointing out the things that escalate into violence could be a good topic for therapy could ultimately create danger for the abused partner if the cycle of violence is still active. The correct answer is:Separate the couple for the remainder of the session.

In the case of unscheduled termination, it is best to: Select one: a. Be sure to collect any unpaid fees promptly to avoid misunderstandings about outstanding bills b. Have the client agree in advance to having a session after the decision to leave therapy in an unscheduled situation c. Provide referrals to the client so that the client may continue therapy in the future d. Require the client to return for a termination session

Answer B is CORRECT: At the very least, the therapist should invite the client who terminates prematurely in for a termination session. Even better would be an agreement that if the client chooses to leave therapy on their own, that they will come in for a session to discuss it with the therapist. Answer A is incorrect: While this may be true, it sidesteps the clinical issues attendant to premature termination.Answer C is incorrect: This answer sidesteps the clinical issues attendant to premature termination. While it is a good idea to give the client referrals, it is also important to make sure the client knows that s/he is welcome to return to therapy as well.Answer D is incorrect: The language here is too strong. The use of the word "require" is very absolute. "B" is a better answer. The correct answer is: Have the client agree in advance to having a session after the decision to leave therapy in an unscheduled situation

A therapist is seeing a client with poorly controlled HIV. He takes medication irregularly, continues to drink alcohol, and avoids group counseling because it is "too depressing". He was referred to you by an HIV/AIDS medical specialist with whom you have a release. The BEST reason for speaking with the medical doctor is to: Select one: a. Determine the extent of the client's medication noncompliance. b. Develop interventions that are consistent with the client's medical status. c. Establish a collaborative team. d. Assure that your recommendations are consistent with the doctor's.

Answer B is correct: A release can be used to further and fine tune the needs of a treatment plan. The medical doctor may have a perspective related to the medical diagnosis that it important for the clinician to know. Releases are not obtained to confirm or disconfirm client self-reports. Actual client compliance and or lack of compliance would only be known by the client and couldn't be determined through a third party (A). The purpose of a release is to promote the client's welfare; the establishment of a team, in and of itself, is not the objective (C). Not all recommendations from the doctor are within the scope of practice of a marriage and family therapist so this answer is not reasonable (D). The correct answer is: Develop interventions that are consistent with the client's medical status

You have been working with a family for eight months, their presenting problems have been resolved, and you have been discussing termination issues on and off for several weeks. They are now taking a month off from therapy to go on a vacation to celebrate and suddenly announce that this will be their last session. How do you BEST respond? Select one: a. Suggest that there are other goals to work on and interpret their behavior as a way of running away from these problems. b. Terminate during this session. c. Terminate, but point out other dysfunctional patterns that have not been addressed and make yourself available for future therapy. d. Suggest that the termination may be premature, and that at least two more sessions would be appropriate.

Answer B is correct: As stated, the family has resolved its presenting problems and has been in discussion with you about terminating. The goals have been met, the clients are ready to end treatment; it would be an appropriate time to terminate. It would be unethical to create therapeutic issues or highlight other problems when clients have resolved their presenting problems and are ready to move on (A). Pointing out other dysfunctional patterns that have not been addressed and making yourself available for future therapy seems like a poor response (C). The family seems to have met the goals of therapy and termination does not appear premature in this case. Although there are different ideas about termination, there are no hard and fast rules about how long the termination process must last (D). The correct answer is: Terminate during this session.

Ralph has been seeing you for individual counseling for one month. You know that he has exhibited suicidal ideation and you have been monitoring him very closely. What information would most heighten your concern regarding the need for involuntary hospitalization? He has: Select one: a. A plan and timetable and no outside methods of support. b. A gun and timetable and will not commit to a self-care plan. c. A plan and a history of poor impulse control. d. Been hospitalized for suicidal ideation twice in the past 15 years.

Answer B is correct: Having a gun indicates that Ralph currently has a highly lethal method to carry out a suicide. He also has a timetable and refuses to make a self-care plan. This indicates his suicide plan is complete and he is extremely lethal. Having a plan without a timetable is less severe than someone with the plan and a timetable. An extremely isolated person with no outside support is certainly a concern for you as the therapist, but not necessarily an indicator that a suicide attempt is imminent (A). Having a plan and a history of poor impulse control is a concern but Ralph's risk could increase rapidly if he were to develop a plan, timetable, and attain a lethal means for attempting a suicide (C). Past hospitalizations are not indicators of the need for involuntary hospitalization at this time. This answer choice gives no indication of a current problem (D). The correct answer is: A gun and timetable and will not commit to a self-care plan.

Derrick, a 16-year-old boy, is mandated to counseling by the juvenile court due to stealing and vandalism. He says to you that he does not want to see you, but he has no choice because he has to fulfill his probation requirement. He says, "don't bother to fix me. I just want you to write a letter to tell my P.O. that I am fine. I am happy; you are happy!" As a psychodynamic therapist, which of the following would be a good intervention in the initial stage? Select one: a. Help him explore and understand his resistance. b. Ask him how he feels about not having a choice to come see you. c. Establish a safe holding environment. d. Assess if he sees you as a "bad" object like he sees the probation officer.

Answer B is correct: This is a good initial stage psychodynamic intervention to explore and understand how Derrick feels in order to establish trust and rapport. Derrick is showing resistance to help but it is premature to help him understand his resistance in the initial stage as the therapeutic relationship is still forming (A). Establishing a safe holding environment is an initial stage treatment goal for psychodynamic therapy (C). The ways to achieve this are through clarifying and containing feelings, recognizing client concerns, clarifying therapeutic boundaries and expectations, etc. Considering Derrick's perception of you would be relevant, but it is not an intervention (D). The correct answer is: Ask him how he feels about not having a choice to come see you.

You are a newly licensed therapist. You would like to incorporate hypnotherapy into your practice. Which of the following statements is CORRECT? Select one: a. Hypnotherapy is not within the scope of MFT practice. b. You may practice hypnotherapy if you are properly trained. c. You are legally required to inform a client in the first session that you use hypnotherapy. d. You may practice hypnotherapy only if you are certified by your state licensing board.

Answer B is correct: An MFT may utilize hypnosis if s/he has the appropriate education, training, and experience. Hypnotherapy is within the scope of MFT practice as long as the practitioner has been properly educated and trained to perform hypnotherapy and has enough experience to do so (A). At the onset of therapy, you are only legally bound to reveal to clients (1) your fee and (2) the owners of a business if any fictitious name is used (C). It is no longer necessary to become certified to perform hypnosis (D). The correct answer is: You may practice hypnotherapy if you are properly trained.

Richard, a 44-year-old endocrinologist, has come to you for bereavement counseling. His wife died 6 months ago in a car accident. Since that time, he has found it hard to get up each morning, he has a difficult time concentrating, and he has not been eating and sleeping well. Richard has lost 30 pounds since his wife's death and says that his life is not the same without her. Cognitive-behavioral therapy would be helpful for Richard because: Select one: a. It will address his cognitive distortions surrounding the finality of death. b. It's an effective treatment for eating disorders and depression. c. It will help him reframe his view of himself, the world, and the future. d. He is well-educated.

Answer C is correct: Cognitive-behavioral therapy can help Richard reframe his view of himself, the world, and the future. A common CBT goal is exploring a client's cognitive triad, how they see themselves, the world and the future. It is likely that Richard 's cognitive triad is slanted towards issues of loss and grief, and he could benefit from reframing his views and highlighting his strengths and ability to recover from tragedy. Addressing Richard's cognitive distortions surrounding the finality of death is not correct because it is too assumptive about the beliefs surrounding death, and the fact that his wife is no longer living is not a distortion (A). Cognitive-behavioral therapy can benefit both eating disorders and depression, however this answer is incorrect because only depression is relevant to this client. It is true he has lost 30 pounds, however there are no indications that he is now underweight, or bingeing and purging to obtain this result (B). The fact that a client is well-educated is not a reason use cognitive-behavioral therapy. The fact he is having difficulty in the grieving process and is seeking help suggests that he could benefit from the shift in thinking that CBT therapy works to create (D). The correct answer is: It will help him reframe his view of himself, the world, and the future.

You receive a call regarding Alex, a depressed, suicidal, 16-year-old. Which of the following would you LEAST likely do initially in order to contain the threat of suicide? Select one: a. Assess for the possibility of drug and alcohol use. b. Meet with Alex alone in order to promote trust. c. Meet with the family to explore for a family history of suicidality. d. Assess for the possibility of child abuse.

Answer C is correct: Exploring for a family history of suicide would be an important intervention for discovering what generational factors may be contributing to Alex's behavior. This intervention, however, would not be an INITIAL measure to contain the threat of suicide. Assessing for the possibility of drug and alcohol, meeting with Alex individually, and assessing for the possibility of child abuse would all be likely initial interventions (A, B, D). The correct answer is: Meet with the family to explore for a family history of suicidality.

The Shippers are a Caucasian middle-class family that come to see you after a big argument. Frank and Maria found out that James has been sneaking out of the house once a week to go and hang out with his friends. They tell you that James' behavior has been getting worse over the past several months and that he refuses to listen to them. When you ask James what happened, he tells you that he is tired of all the fighting and that no one understands him. Maria tells you that she has tried pleading with James to be better, giving him more privileges, and even reassures him that he is cared for. Maria says that she is exhausted and does not know how to make a change. Frank tells you that they need to just set more boundaries to change this behavior. Annie quietly sits in the corner playing with her mothers' phone. How would a Bowenian therapist MOST likely conceptualize this case? Select one: a. The family needs help differentiating their thoughts from their feelings. b. Frank and Maria are sending mixed messages to James and need to develop a stronger parental subsystem. c. Frank and Maria are using James to minimize discomfort that they have in their relationship. d. James is struggling with his sexuality and needs his parents to understand and accept him.

Answer C is correct: James, Maria, and Frank are all caught in a triangle. Bowen would likely conceptualize this case by recognizing that James is easing any discomfort Frank and Maria are feeling about their marriage. Although this answer choice is describing the concept of differentiation, it does not help you understand the bigger issues of a family triangle (A). The language in this answer choice is more in with a structural framework (B). The genogram does indicate that James is gay, and the vignette also indicates that James is feeling misunderstood, however this is only one piece of what the family is dealing with; however, answer choice C is a better response when thinking about conceptualizing this case within a multigenerational framework (D). The correct answer is: Frank and Maria are using James to minimize discomfort that they have in their relationship.

Sasha, a college freshman, has been having difficulties adjusting to living away from home for the first time. She reports feeling isolated, drinking more, and says she is failing two classes. One night, Sasha calls and says that she is having recurring thoughts of jumping off the campus bell tower. What should you do? Select one: a. Give Sasha the number of the Suicide Prevention Hotline and encourage her to call them if she feels that she might act on these thoughts. b. Tell Sasha that you will make arrangements with the college hospital for her to check in and be kept safe. c. Try to get Sasha to agree not to harm herself until your next session and schedule a session as soon as possible. d. Contact Sasha's family and involve them to help create an emergency support system.

Answer C is correct: This response deals directly with Sasha's expression of suicidal ideation by providing containment and accountability with a self-care plan and scheduling an additional session as soon as possible. Giving Sasha the number of the Suicide Prevention Hotline is an under-reaction to a client who calls to say she is thinking about suicide (A). A therapist would need to establish some level of accountability and safety for the client. If the therapist were to reach an agreement with Sasha that she would promise to call the Suicide Prevention Hotline before acting, that would be a more reasonable intervention. Telling Sasha that you will make arrangements with the college hospital for her to check in and be kept safe is an over-reaction. If, during the phone call, Sasha indicates that she is imminently suicidal, then a voluntary hospitalization could be a reasonable response. However, there is not enough information here to warrant hospitalization (B). Breaking confidentiality and contacting her family is also an over-reaction at this point, unless Sasha will not agree to not harm herself (D). The correct answer is: Try to get Sasha to agree not to harm herself until your next session and schedule a session as soon as possible.

You're treating a man whose wife is an active alcoholic. He works full-time and assumes most of the responsibility for the care of their two children. In trying to get his wife to stop drinking, he waters down her bottles of Scotch. Today he comes to therapy complaining about his wife's recent increase in drinking binges, which he feels powerless to stop. How BEST would you proceed? Select one: a. Expand the unit of treatment to include his wife b. See the wife to determine the extent of her alcoholism. c. Emphasize the man's need to utilize better self-care. d. See the children to assess for the possibility of child abuse.

Answer C is correct: Your client must learn to take care of himself so that he can attend to his own needs and the needs of his children. Expanding the unit of treatment to include the wife would not be indicated unless she was willing to participate in recovery (A). The husband is your client, not the wife. The presenting problem remains his ability to cope with her addiction (B). There are too many unknowns to automatically assume that child abuse is occurring. If there were anything alluded to in this vignette about the kids not being taken care of, assessing them could be appropriate (D). The correct answer is: Emphasize the man's need to utilize better self-care.

Your new client, a college freshman, says she sometimes has an "out of body" experience in which she is watching what she is doing from outside herself. She describes a recent experience in which she was in her dorm room writing a paper when she realized she couldn't feel her fingers on the computer keyboard or her feet on the floor and then suddenly felt like she was watching herself from the ceiling. The client says that these episodes make her feel like she's "going crazy" and are interfering with her ability to attend class and complete course assignments. The client's symptoms are most suggestive of a DSM-5 diagnosis of: Select one: a. Delusional Disorder b. Dissociative Fugue c. Depersonalization or Derealization Disorder d. Depersonalization Disorder

Answer C is correct: Depersonalization/Derealization Disorder is characterized by recurrent episodes of depersonalization (a sense of unreality, detachment, or being an outside observer of one's thoughts, feelings, etc.) and/or derealization (a sense of unreality or detachment involving one's surroundings) that cause clinically significant distress or impaired functioning. Answer A is incorrect: Delusional Disorder involves one or more delusions that last at least one month. As defined in the DSM-5, a delusion is "a false belief based on incorrect inference about external reality that is firmly held despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary" (p. 819). Answer B is incorrect: A dissociative fugue is characterized by apparently purposeful travel with an inability to recall some or all of one's past and is included in the DSM-5 as a specifier for Dissociative Amnesia. Answer D: is incorrect: Depersonalization Disorder is a DSM-IV-TR diagnosis and has been renamed Depersonalization/Derealization Disorder in DSM-5. The correct answer is: Depersonalization or Derealization Disorder

You've been seeing a couple for marital therapy. The husband arrives for their weekly session alone and reports that his wife is staying in the car. He says that she refuses to come to your office because you are always taking his side. He wants to go ahead with the session without her. You decide to: Select one: a.Proceed with the session, seeing him alone. b.Terminate therapy and give him a referral to another therapist. c.Make another appointment for both, since the couple is your client. d. Go down to the car and ask the wife to come in so that you can explore this issue.

Answer C is correct: In conducting marital therapy, your client is the couple. By asking that both partners be present, you are demonstrating that you do not take sides. This might encourage the wife to attend the next session in order to explore her feelings of being treated unfairly. Answer A is incorrect: Working with the husband alone would confirm his wife's fears. Answer B is incorrect: Referring to another therapist might also confirm her fears and the therapist would miss a valuable opportunity to maintain boundaries and to clarify the nature of the relationship. Answer D is incorrect: Going down to the car weakens the therapeutic boundary and reinforces the wife's symptomatic behavior, giving it greater power. The correct answer is:Make another appointment for both, since the couple is your client.

A new client comes in complaining of feeling depressed. He reports feeling hopeless, not eating well, and having difficulty falling asleep at night. He has stopped contacting friends and misses work when he feels too upset to get out of bed. You suspect that the client may be self-destructive. Given that this is a new client and you are in your first meeting with him, how would you proceed? Select one: a. Engage the client and continue gathering a biopsychosocial history, while also observing the client for additional, nonverbal signs suggesting that he poses a danger to himself at this time. b. Identify the specific events and situations that led to the client's current distress and ways to meet his immediate needs. c. Conduct a structured inquiry to obtain information as a basis for determining an appropriate plan to protect the client from hurting himself. d. Encourage voluntary commitment to a psychiatric facility by the client, utilizing his available support system.

Answer C is correct: Whenever you suspect that a client is at risk for suicide, you should address this immediately through the use of direct questions - e.g., "Have you ever thought about hurting yourself?" "Do you plan to hurt yourself?" When a client responds in the affirmative to these questions, the next step is to determine his level of risk for an immediate suicide attempt. In particular, you should obtain information about the client's suicide plan and whether the client has acquired the means to carry out his plan, as this will tell you how far the client has proceeded in thinking about killing himself. The risk to life is highest when the client has both a lethal suicide plan and the means available to carry it out. The steps you then take to protect the client should be consistent with the level of risk currently posed by the client. If lethality is assessed to be low, you should talk over the problem with the client, attempting to elicit his ambivalent feelings about suicide; offer emotional support; and explore alternatives for meeting the client's immediate and later needs. The latter may include providing referrals for outside help. You should also obtain an agreement from the client to contact you should there be any change in his situation, such as increased hopelessness leading to more concrete suicidal thoughts. If lethality is assessed to be high, then you need to take a more directive approach. Beginning with the least intrusive measure, you would take one or more of the following steps: (1) Attempt to develop a no-suicide contract in which the client promises to not commit suicide for a specified period of time, to not stay alone during that period of time, to remove all lethal means of suicide from his immediate environment, and to contact you or a suicide hotline if he feels worse or feels an impulse to commit suicide; suggest that the client temporarily stay with friends or relatives; and arrange to see the client more often, at least temporarily, and to have the client touch base with you over the phone at regular intervals. (2) If the client cannot or will not make these promises, then you should notify members of the client's immediate support system about the client's condition. In addition to providing support, family members or close friends can be a source of logistical help, by keeping an eye on the client and making sure that all weapons are removed from the client's immediate environment. (3) If lethality is assessed to be very high - i.e., the client has a lethal plan and previous attempts and is socially isolated - and/or if the client won't or can't cooperate with any of the above methods of self-protection (whether due to resistance, psychosis, substance abuse, or the lack of available social support), then hospitalization is necessary. First, encourage voluntary commitment to a psychiatric facility by the client, utilizing the client's available support system. If the client won't enter a facility voluntarily, then arrange for an involuntary hold by contacting a person or agency designated by your county. Follow-up with the client until the crisis is stabilized.Answer A is incorrect: You should not hesitate to explore the risk for suicide when you suspect that a client may pose a danger to himself. Even before rapport has developed, a suicide assessment can take place through a structured inquiry that explores key factors associated with suicidality (e.g., intent, plan, means). The correct answer is: Conduct a structured inquiry to obtain information as a basis for determining an appropriate plan to protect the client from hurting himself.

A couple is referred by the court for domestic violence episodes. They have been working hard on anger management and "fair fighting," and the man recently joined a batterers group. During this session, the man seems withdrawn and tense. He was just laid off and he's very angry about it. They begin arguing about money and the man becomes increasingly volatile quickly. Given this man's history of violence, the first thing you should do is: Select one: a. Call the police. b. Remind the husband of his progress with self-control. c. Leave the room with the wife. d. Ask him to leave immediately.

Answer C is correct: Your first priority is safety, both your client's and your own. Leaving the room with the wife takes both of you out of immediate danger and gives the husband an opportunity to cool down. Answer A is incorrect: You may want to call the police if you feel the danger of violence is imminent. However, the question asks what you would do FIRST, which is remove yourself and the wife from danger. Answer B is incorrect: Reminding the husband of his progress with self-control runs the risk of being seen as confrontational or condescending. This may only upset the husband further. Answering D is incorrect: Asking the husband to leave runs the risk of being interpreted as confrontational, which is not advisable in a potentially violent situation. The correct answer is: Leave the room with the wife.

The term double bind refers to: Select one: a. Repeated physical abuse b. Intense affiliation c. Loyalty conflicts d. Contradictory communication

Answer D is Correct:Choice d is the correct answer. A double bind is a dilemma in communication. It is a set of contradictory or logically inconsistent communications from the same person along with an injunction that the receiver of the communications must not comment on their inconsistency. A common example is where a parent says "I love you" to their child while pushing the child off of their lap. The correct answer is: Contradictory communication

The Davis family consists of Mom, Dad, Ron, 19, and Debbie, 15. When Ron was 16, he quit school, and, after several scrapes with the law, joined the Army at 18. According to mom, Debbie has been hanging around with the wrong crowd. Recently, Debbie discovered that she was pregnant. Debbie is thinking of leaving home to live with a girlfriend who is also pregnant. When together, the family members often engage in openly hostile fighting. What would be an early stage goal for a structural therapist? Select one: a. Challenge family structure and reduce emotional reactivity. b. Alleviate the fighting and create second order change. c. Improve communication skills. d. Reduce the fighting by re-labeling the problem to create a first order change.

Answer D is correct: A structural therapist would want to establish a first order change with such interventions as challenging the fighting (symptom) and re-labeling the problem (reframing). A structural therapist would alleviate the symptom, not challenge the family structure, in the early stage. Emotional reactivity is also a Bowenian term (A). Alleviating the fighting would be an early stage goal, but second order change would not occur in the early stage of therapy (B). Improving communication skills would not be an early stage goal for structural therapy, although it is something a structural therapist would want to do later in the middle stages (C). The correct answer is: Reduce the fighting by re-labeling the problem to create a first order change.

The boyfriend of your teenage client calls and tells you she has been taken to the emergency room because she was partying to the point that she hallucinated and passed out. Her boyfriend called you because he thought you should know what's going on because he is afraid you don't know. When she comes for therapy that week, she tells you that her boyfriend should not have called you and says she does not have a problem with drugs. You would MOST likely: Select one: a. Tell her that confidentiality may be broken in medical emergencies. b. Explore with her how her boyfriend may have been feeling. c. Ask how she would define a problem with drugs. d. Express concern for her safety when she passed out and define passing out as a sign her use has become dangerous.

Answer D is correct: Expressing concern for her safety when she passed out and defining passing out as a sign her use has become dangerous will address her denial, which is preventing her from disclosing it in therapy and starting a path to recovery. Telling her about the limits of confidentiality would not address her statement about not having a problem. Addressing her denial is an important step to getting her help and creating safety (A). Exploring how the boyfriend is feeling would make her feel ganged up on at this moment and not lead her out of denial and into recovery (B). Asking how she would define a problem with drugs allows her to further her denial by giving examples of things she does not do, instead of the consequences she does experience as a result of her use (C). The correct answer is: Express concern for her safety when she passed out and define passing out as a sign her use has become dangerous.

Verna, a 66-year-old African American woman, comes to see you for help in dealing with her 12-year-old grandson's out-of-control behavior. She is raising him along with his 8-year-old sister, and reports that she doesn't want him to follow his father's footsteps and end up in prison. In developing a therapeutic alliance with Verna, your first concerns are MOST likely centered around: Select one: a. Her parenting abilities. b. Being open about the racial/ethnic differences between you and her. c. Realizing she may want to focus on the history and causes of the problem. d. Showing respect for her child-rearing experience.

Answer D is correct: In forming a therapeutic alliance with Verna, acknowledging her experience in raising a family will contribute to her trust of you. It also shows sensitivity to the importance African Americans place on the family. Working on Verna's parenting abilities is going to be part of the focus of treatment. However, your first concern is in building a relationship with her, showing respect for her accomplishments, such as child-rearing (A). Assuming you are not an African American, being open about the racial/ethnic differences between you and her is important and would be an early concern. However, answer choice D addresses the question of how to build rapport with this new client (B). In general, African Americans tend to not want to divulge a lot of history, especially at first, and tend to be less interested in analyzing the causes of a problem than getting ideas about solutions to the problem (C). The correct answer is: Showing respect for her child-rearing experience.

You have begun therapy with a family of seven. The wife has three children from her previous marriage and the husband has two children from his previous marriage. The parents both have full custody of the children, all of whom are under the age of 15. Initially, the family functioned well, but in recent months, there has been a breakdown of communication and the children are accusing their parents of taking sides. The parents should be informed that: Select one: a. What they are experiencing is normal and that proper adjustment will naturally occur over time. b. When working well, biological families and stepfamilies function and are structured in much the same way. c. Traditional family systems therapy is the most effective approach for the treatment of stepfamilies. d. Stepfamily dynamics must be addressed differently than biological family dynamics.

Answer D is correct: Therapists should have knowledge and training in the unique dynamics of stepfamilies in order to be most effective. Although what this family is experiencing may be common among blended families, telling them that adjustment will naturally occur would not be appropriate. It minimizes their experience and makes a false guarantee (A) Biological families and stepfamilies function and are structured quite differently. When functioning well, these differences would be respected and understood (B). Traditional family systems therapy is generally based on biological family systems. Therapists should have knowledge and training in the unique dynamics of stepfamilies in order to be most effective (C). The correct answer is: Stepfamily dynamics must be addressed differently than biological family dynamics.

You are treating a client who is a recovering alcoholic with 6 months of sobriety. Your client arrives late to the session stating his son was arrested for drunk driving and that he had to take him to court. Your immediate goal in this situation would be to: Select one: a. Get the son to an Alcoholics Anonymous meeting. b. Educate the father about multigenerational alcohol problems. c. Invite the son in for individual therapy. d. Educate your client about the risk for a potential relapse.

Answer D is correct: Educating your client about the risks of a potential relapse during a family crisis is the only answer that directly deals with the client's immediate needs. The son is not your client so it's not necessary to make referrals or see him for therapy (A, C). Educating the father about multigenerational alcohol problems would be an appropriate goal later on (B). The correct answer is: Educate your client about the risk for a potential relapse.

The Millers come to therapy because they fear their child has Autism Spectrum Disorder. They tell you their 10-month-old son still feeds himself with his hands, does not show evidence of language skills, and often rocks back and forth on his hands and knees before he crawls. How would you proceed? Select one: a. Conduct tests for Autism Spectrum Disorder. b. Refer them to a pediatrician. c. Refer them to speech and physical therapy. d. Educate the parents on child development.

Answer D is correct: A 10-month-old not using utensils, not having language, or rocking in preparation to crawl would not be considered abnormal. Psychoeducation would be an appropriate intervention. You would not conduct tests for Autism Spectrum Disorder for two reasons. First, children don't typically develop the ability to use utensils until they are 12-18 months, and a 10-month-old who hasn't developed language would not be considered abnormal. In addition, a psychologist, not an MFT, would be the appropriate person to conduct tests for Autism Spectrum Disorder (A). Although a therapist could make a referral to a pediatrician, there are no indicators in the vignette of any physiological problems or circumstances that would be considered abnormal in a 10-month-old (B). A therapist would not need to make a referral to speech or physical therapy. A 10-month-old child would not be considered abnormal for not using utensils, not having language, or rocking in preparation to crawl, so these referrals would be unnecessary (C). The correct answer is: Educate the parents on child development.

A client is angry at his neighbor for cutting down a large tree that gave the client privacy in his backyard. The client is agitated and tense as he describes this event and says that he and the neighbor had a heated argument about it the day before, in which the neighbor called him a "loser." The client has a history of poor impulse control, including stealing and excessive alcohol use. He has been arrested on several occasions for bar fights, which he initiated, and has spent time in jail. Which of the following is the BEST predictor of the potential that this client may act violently toward his neighbor? Select one: a. The nature of the recent provocation b. The client's poor impulse control c. The client's agitation and tension d. The client's past violent behavior

Answer D is correct: All of the factors listed in the answers are indicators of an increased risk for violent behavior, but the best predictor of future violent behavior is past violent behavior. The correct answer is: The client's past violent behavior

The symptoms of Oppositional Defiant Disorder are categorized in three groups in the DSM-5. These groups are: Select one: a. destruction of property, deceitfulness or theft, and serious violations of rules. b. negativistic, defiant, and hostile behavior. c. deceitfulness or dishonesty, irritability or aggressiveness, and failure to conform to social norms. d. angry or irritable mood, argumentative or defiant behavior, and vindictiveness.

Answer D is correct: Angry/irritable mood, argumentative/defiant behavior, and vindictiveness are the three categories of symptoms included in the DSM-5 for Oppositional Defiant Disorder. Answer A is incorrect: These are three of the four categories of symptoms included in the DSM-5 for Conduct Disorder (the fourth is aggression to people and animals). The correct answer is: angry or irritable mood, argumentative or defiant behavior, and vindictiveness.

Steve and Irene, a middle-aged, middle-class couple, come to see you. Steve complains that he has to fix dinner for himself and the kids and then gets them ready for bed. He then goes to bed alone, while Irene "moans and groans on the couch about some made-up dizziness." Steve berates her in the session, calling her, "a liar and a lazy, good-for-nothing woman." In exploring Irene's view of the problem, you learn that Irene feels faint, dizzy, has double vision, and feels weak and nauseated just before her husband comes home from work. She finds she must lie down and does not recuperate until after Steve has gone to bed. She then feels better which is consistent with her doctors being unable to find any physical problem with her. This has been going on for about 2 months. There is no indication that she is faking the symptoms, even though her husband accuses her of this. With the information given, what would be Irene's most likely DSM-5 diagnosis? Select one: a. Illness Anxiety Disorder b. Factitious Disorder c. Somatic Symptom Disorder d. Conversion Disorder

Answer D is correct: Conversion disorder involves a loss of physical functioning as a result of psychological factors. A feature of conversion disorder is that a person is not intentionally producing symptoms and Irene does not appear to be doing so. Illness anxiety disorder requires the presence of mild somatic symptoms with disproportionate worry and behaviors related to that worry. Irene does not report distress with her symptoms (A). Factitious disorder is used when a person deliberately falsifies symptoms. There is nothing in the vignette to suggest that Irene is purposely falsifying her symptoms (B). Somatic symptom disorder requires six months of the presence of one somatic complaint accompanied by excessive thoughts, worry or behaviors related to that complaint. The vignette does not provide information about 6 months of symptoms or worry about those physical symptoms (C). The correct answer is: Conversion Disorder

Which of the following is not a DSM-5 diagnostic criterion for Conversion Disorder? Select one: a. one or more symptoms that involve an alteration in sensory or motor functioning b. evidence of incompatibility between the symptoms and known medical conditions c. symptoms are not better explained by a medical condition or other mental disorder d. evidence that the symptoms are related to a psychological need or conflict.

Answer D is correct: The DSM-IV-TR requirement for evidence that symptoms are associated with psychological factors has been removed as a diagnostic criterion for Conversion Disorder in the DSM-5. Answers A, B, and C: These answers describe the DSM-5's diagnostic criteria for Conversion Disorder. The correct answer is: evidence that the symptoms are related to a psychological need or conflict.

Your 19-year-old client tells you that he has been abused by his father since he was little but has managed how to deal with it. What is your legal obligation? Select one: a. Develop a safety plan if he is still living with his father. b. Report child abuse. c. Assess whether there are more children in the home. d. Assess whether the father is still abusing other children

Answer D is correct: To determine if you have a mandate, you must assess whether there are children who are likely to be abused by your client's father. Developing a safety plan is not your first legal requirement. You are obligated by the standard of care rule to develop interventions that serve the best interests of the client, but in cases of child abuse, you need to assess if you have a mandate first (A). The client is 19, and because he is not a minor, you have no obligation to report on abuse occurred by your client (B). Assessing whether there are more children in the home doesn't go far enough. To determine if you have a mandate, you must assess whether there are children who are likely to be abused by your client's father (C). The correct answer is: Assess whether the father is still abusing other children.

The clients in advocacy consultation are: Select one: a. children b. people who have been declared legally incompetent c. members of a disenfranchised group d. people in a legal proceeding

As its name implies, advocacy consultation involves acting as an advocate. It is a political form of consultation that has, as its primary goal, social change.Answer C is CORRECT: The individuals listed in responses a, b, and d might be the clients in advocacy consultation, but this answer is best because it includes these individuals as well as others who may be disenfranchised. Answer A is incorrect: See explanation for response c.Answer B is incorrect: See explanation for response c.Answer D is incorrect: See explanation for response c. The correct answer is: members of a disenfranchised group

The therapist is seeing an American Indian family--husband, wife, children, and the husband's father, who lives with them. The therapist notices that the wife keeps referring to her father-in-law as "he," rather than using his name. The therapist should: Select one: a. ask the father-in-law his name b. ask the family about their habits regarding names and relationships c. accept the wife's language as a cultural norm d. confront this, as it appears to be a sign of disrespect

Asking the father-in-law to tell you his name could be insensitive if it is a cultural or family norm for younger in-laws to not use his name. In other words, you could be breaking the rules.Answer B is CORRECT: This approach allows you to respectfully discover the rules.Answer A is incorrect: See the explanation above. In addition, your first instinct may have been that this approach is too simplistic. If so, you were right. The question included important details about culture that clearly suggested that this would not be the best thing for a therapist to do.Answer C is incorrect: This is a truism: yes, you should respect your clients? cultural norms, but merely "accepting" the daughter-in-law's behavior would not provide you with any new and possibly useful information. There is nothing disrespectful or "nonaccepting" about asking the family to tell you about their cultural habits. In addition, in this case, you can't even be certain that the daughter-in-law's behavior does represent a cultural norm.Answer D is incorrect: This is a judgmental choice--the behavior in question could be common and appropriate in the clients? culture. The correct answer is: ask the family about their habits regarding names and relationships

In order to detect how language produces changes in people and provide a more systematic explanation of how therapists work and how their intervention strategies help clients reprogram their behavior, mathematician Richard Bandler and linguist John Grinder studied the linguistic patterns of: Select one: a. Gregory Bateson b. Jay Haley and Cloe Madanes c. Fritz Perls, Virginia Satir, and Milton Erickson d. Milton Erickson

Bandler and Grinder's inquiry was based on neurolinguistic programming (NLP), which hypothesizes that all behavior results from neurological processes ("neuro"); that these processes are ordered, sequenced, and represented into strategies and models through language ("linguistic"); and that the process of organizing a system's components determines specific outcomes ("programming"). Answer C is CORRECT: This is correct. Answer A is incorrect: Answer "c" is correct. Answer B is incorrect: Answer "c" is correct. Answer D is incorrect: Answer "c" is correct. The correct answer is: Fritz Perls, Virginia Satir, and Milton Erickson

A behavioral therapist would be most likely to say that symptoms are the result of which of the following? Select one: a. underlying conflicts b. irrational thoughts and beliefs c. learning d. physiological processes

Behavior therapists view symptoms (maladaptive behaviors) as the result of earlier learning and, therefore, believe that symptoms can be unlearned. The foundation of all behavioral treatments is the application of scientifically-generated principles of learning to the modification of behavior.Answer C is CORRECT: As indicated above, this is the right answer.Answer A is incorrect: This would be characteristic of a psychoanalytic therapist.Answer B is incorrect:This would be of interest to a rational emotive therapist.Answer D is incorrect:This concern is characteristic of Hull, who believed that learning does not occur unless drive (basic physiological needs such as thirst, hunger, and sex) is reduced. He felt that only those behaviors and responses that result in drive reduction become learned behaviors and responses. The correct answer is: learning

In general systems theory terms, negative feedback is different from positive feedback in that: Select one: a. positive feedback operates to reduce any tendency toward deviation while negative feedback leads to change b. negative feedback operates to reduce any tendency toward deviation while positive feedback leads to change c. in fact, these two terms are mechanistic and have no meaning in any theoretical construct d. in fact, positive and negative feedback both lead to change within a system

Both negative and positive feedback are involved in homeostasis. Negative feedback has also been called "stabilizing" or "leveling" feedback because it serves to maintain equilibrium. By contrast, positive feedback has also been called "escalating" or "attenuating" feedback because it serves to take a system out of equilibrium and eventually lead to change.Answer B is CORRECT: This statement accurately describes these two complementary processes.Answer A is incorrect: The two terms are reversed in this statement.Answer C is incorrect: In fact, these terms are central to general system theory.Answer D is incorrect: This statement is not accurate, since negative feedback does not lead to change. The correct answer is: negative feedback operates to reduce any tendency toward deviation while positive feedback leads to change

For a therapist relying on Beck's cognitive approach to treat a client suffering from an Anxiety Disorder, the initial cognitive restructuring will most likely focus on: Select one: a. reattribution b. cognitive rehearsal c. thought stopping d. decatastrophizing

Cognitive therapists use a variety of cognitive strategies, and many of the strategies are the same, regardless of the client's disorder. However, some techniques are better suited to certain disorders, especially as initial interventions.Answer D is CORRECT: Decatastrophizing is particularly useful for people with an Anxiety Disorder since they tend to overestimate the risk and consequences of perceived danger.Answer A is incorrect: Reattribution involves attributing responsibility to appropriate parties and is most useful when the client is depressed or guilt-ridden.Answer B is incorrect: Cognitive rehearsal requires the client to imagine each step involved in an activity or task.Answer C is incorrect: Thought stopping may be useful but it is usually classified as a behavioral (not cognitive restructuring) technique and would probably not be an initial intervention in treating a client with an Anxiety Disorder. The correct answer is: decatastrophizing

Paralanguage, one of the characteristics of communication identified by Sue and Sue (2003) as being influenced by culture, refers to the use of: Select one: a. personal and interpersonal space b. facial expressions, gestures, eye contact and other bodily movements c. loudness of voice, silence, rate of speech, and other vocal cues d. culturally shared meanings for certain words and phrases

D. W. Sue and D. Sue describe several aspects of communication that are influenced by culture and may affect interactions between people from different cultural backgrounds (Counseling the Culturally Diverse: Theory and Practice, New York, John Wiley, 2003).Answer C is CORRECT: Paralanguage refers to the vocal cues (other than language itself) that are used to communicate meaning. Answer A is incorrect: Proxemics refers to the personal and interpersonal use of space.Answer B is incorrect: Kinesics refers to the use of bodily movements as means of communication.Answer D is incorrect: Paralanguage does not refer to culturally shared meanings for words and phrases. The correct answer is: loudness of voice, silence, rate of speech, and other vocal cues

During the first session with a new client, you notice that his speech is rapid and rambling, he has grandiose plans for the future, he's distracted and restless, and says he hasn't been sleeping much lately. The client also says that he's had these symptoms continuously for a couple of weeks. The most likely DSM-5 diagnosis is: Select one: a. Caffeine Intoxication. b. Bipolar I Disorder. c. Panic Disorder. d. Hyperactive Personality Disorder

Familiarity with the major features of the disorders listed in the answers would have helped you identify the correct answer to this question. Answer B is correct: The nature and duration of the client's symptoms are consistent with a diagnosis of Bipolar I Disorder. Answer A is incorrect: Caffeine intoxication involves the development of characteristic symptoms after recent consumption of caffeine. Although Caffeine Intoxication and Bipolar I Disorder share some symptoms, the client's symptoms and their duration are more consistent with Bipolar I Disorder. Answer C is incorrect: The diagnosis of Panic Disorder requires the presence of recurrent unexpected panic attacks. The client's symptoms are not characteristic of a panic attack. Answer D is incorrect: Hyperactive Personality Disorder is not a DSM diagnosis. The correct answer is: Bipolar I Disorder.

A therapist wants to help a family "reauthor" their lives. The father is telling a story about a problem they've been experiencing. The therapist should ask: Select one: a. "Tell me more about the story." b. "When did this happen?" c. "Then what happened?" d. "What is your involvement with the story?"

If you were looking for the perfect answer and didn't find it, don't be too surprised. The word "reauthor" should have led you to realize that this question is referring to narrative therapy, in which the therapist collaborates with the clients to construct a "story" about their experience, which offers more opportunity for growth and solutions than the version they are currently locked into.Answer D is CORRECT: This answer at least implies that the clients "involvement" in the story is important; i.e., the meaning they are making of the story, where they fit in, etc.Answer A is incorrect: Answers "a," "b," and "c" are straightforward, information-gathering questions, which might be asked in any standard assessment situation.Answer B is incorrect: See above explanation.Answer C is incorrect: See above explanation. The correct answer is: "What is your involvement with the story?"

From a systems perspective, the information that family members continuously exchange, which helps minimize deviation and maintain the family's stability, is referred to as: Select one: a. mimesis b. the family projection process c. negative feedback d. positive feedback

In general systems theory, the information exchanged between family members can act as either positive or negative feedback.Answer C is CORRECT: Negative feedback is corrective and helps the system return to or maintain its steady state. Thus, a "negative feedback loop" helps to minimize deviation and thereby maintain the family's stability. Answer A is incorrect: Mimesis is a therapeutic technique in which the therapist joins the family system by imitating its manner, style, or affective range, or the content of its communication.Answer B is incorrect: Bowen described the family projection process as the mechanism through which parental conflicts are transmitted onto the children.Answer D is incorrect: Positive feedback increases deviation from a steady state and, therefore, disrupts the family system's homeostasis (or "stability" as the question says). The correct answer is: negative feedback

It is the first session with a remarried family consisting of a wife, her new husband, and her 9-year-old son. He has no children of his own. The son is demonstrating some severe behavioral problems. The stepfather sees that his wife is very stressed by parenting and he offers to take care of the child on the weekends when the boy is not visiting with his biological father, so that his wife can have a break. What should be the unit of treatment? Select one: a. The two newly married adults initially, with possible inclusion of the biological father later. b. The stepfather and stepson to build their relationship and then family therapy. c. The mother, son, and biological father at first, then the newly married husband and wife. d. The child alone at first to detriangle him and to build an alliance with the therapist, then family therapy.

It is disturbing that none of the answer choices directly addressed the ". . . severe behavioral problems. . . ," described in the question. As a family therapist we want to be supportive of the family unit, and one answer does that best.Answer A is CORRECT: The literature on blended families emphasizes that the relationship of the married couple is primary. The literature also suggests that the biological parent should continue to take basic responsibility for parenting rather than shifting it to the stepparent. Note: this would not be true if the biological parent was deceased or was not in the child's life.Answer B is incorrect: For the reasons given above, the therapist would want to focus on the couple.Answer C is incorrect: While this may have been appealing since it focuses the biological parents? attention on their child, this therapy format could reawaken fantasies of family reunification in the child.Answer D is incorrect: This would not be a good answer choice based upon the information given in the case description. The correct answer is: The two newly married adults initially, with possible inclusion of the biological father later.

You are referred a young client from a school counselor. After two initial sessions, during which you do a thorough assessment, you suspect that she has an Eating Disorder. For the purposes of diagnosis and referral, you should do which of the following? Select one: a. refer her to an MD or psychiatrist b. further assess for an Eating Disorder c. assess for school problems d. refer her to another school counselor

It seems that this question was asking what the best referral would be to help you make a proper diagnosis and to serve as a useful adjunct to therapy. Answer A is CORRECT: This is clearly the best answer. Many people with Eating Disorders are in denial, and, therefore, initial interviewing and assessment will not always be enough to make a proper diagnosis. A medical doctor can often find physical evidence of the disorder. Also, since this disorder can have serious physical problems associated with it, an Eating Disorder should always be treated in conjunction with a medical doctor. A psychiatrist would not be your first referral, but psychiatrists are medical doctors and so, this is a better choice than the others. Answer B is incorrect: The case already states that you've done a thorough assessment, during two sessions. It does not seem useful to do another assessment. Answer C is incorrect: This client may have school problems but these would not be as important to address as the Eating Disorder. Answer D is incorrect: This is unlikely to be a useful referral. The correct answer is: refer her to an MD or psychiatrist

In the context of managed health care, "gatekeeper" refers to the: Select one: a. peer review board b. HMO c. clinical supervisor d. primary care physician

Managed care reduces health costs in several ways including the use of a "gatekeeper" who makes referrals to specialists.Answer D is CORRECT: The gatekeeper is the person who makes referrals to a psychotherapist or other specialist or the person who evaluates the individual to determine if additional care is needed. Very often, the gatekeeper is the individual's primary care physician.Answer A is incorrect: See explanation for response d.Answer B is incorrect: See explanation for response d.Answer C is incorrect: See explanation for response d. The correct answer is: primary care physician

A woman who attends the same church that you attend wants you to be her therapist. To the best of your knowledge, you've never had any direct contact with the woman at church or elsewhere. You should: Select one: a. not see her since doing so would constitute a multiple relationship. b. agree to see her only if you start attending a different church. c. agree to see her since you haven't had previous contact with her. d. agree to see her but avoid participating in the same small groups or activities at church.

Multiple relationships are addressed in Standard 1.3 of the Code of Ethics (AAMFT, 2015).Answer D is CORRECT: This answer is most consistent with the requirements of Standard 1.3 which states: "Therapists ... make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk for exploitation." Avoiding close contact with the client at church would help reduce the risk for impaired judgment or exploitation. Answer A is incorrect: Although this situation may constitute a multiple relationship, not all multiple relationships are unethical, so this is not the best answer. Answer B is incorrect: Attending another church would be a possible solution to this dilemma, but it is not required. Consequently, this is not the best answer of those given. Answer C is incorrect: The fact that you haven't had previous contact with the woman doesn't address the problem of future contacts with her at church. The correct answer is: agree to see her but avoid participating in the same small groups or activities at church.

How would a Narrative therapist review progress in family therapy? Select one: a. Ask each family member to write session notes and read them together. b. Discuss the family's progress collaboratively with other therapists. c. Ask family members to write letters to each other. d. Evaluate if treatment goals have been met.

Narrative, like other post-modern approaches, sees the clients as the experts in their own lives and that they are best able to evaluate and describe their own progress.Answer A is CORRECT: See above explanation.Answer B is incorrect: Discussing the family's progress with other therapists suggests that confidentiality might be breached. A reflecting team, with the permission of the clients, is frequently employed in Narrative therapy, but the question does not mention this.Answer C is incorrect: Letter writing is a technique utilized by Narrative therapists, but the letters are usually from the therapist to the family.Answer D is incorrect: This is too general an answer and not something specific to Narrative therapists. The correct answer is: Ask each family member to write session notes and read them together.

HIPAA's Privacy Rule regulates the use and disclosure of protected health information (PHI) held by "covered entities." When MUST a covered entity disclose PHI? Select one: a. to facilitate treatment b. when performing health care operations c. to receive payment d. when reporting suspected child abuse

Note that this question is asking when a covered entity MUST disclose confidential information.Answer D is correct: A covered entity MUST disclose relevant PHI when required to do so by law, such as to report suspected child abuse to the appropriate authorities. A covered entity MAY disclose PHI when certain conditions are met to facilitate payment, perform health care operations,and receive payment. The correct answer is: when reporting suspected child abuse

A family, consisting of Mom, Dad, and two children, a 12-year-old girl who is the identified patient, and a 14-year-old boy, come to see you. In the first stages of therapy as a systems theorist, you should: Select one: a. build rapport with each family member individually b. observe from a neutral position c. ask each member what is going on in the family d. ask Mom and Dad to talk about how they would like the 12-year-old to change

Notice that three of the answers suggest separating the family or sending them to separate helping sources. Answer A is CORRECT: This is the only answer that addresses the family issues systemically. Again, systems theorists are interested in how the system is supporting a problem, rather than in supporting the view that one or two individuals are creating the problem. Therefore, the first step for a systems theorist in this situation is to gather information from all the family members. Answer B is incorrect: Although this is a typical intervention for a Bowenian, it is not typical for a general systems theorist. Most systems theorists would not meet with the parents separately since this would identify them as the "problem," or "symptom bearers" for the family. Answer C is incorrect: This may eventually be a useful referral but, so early in therapy, it will only identify the girl as "sicker" and take the focus off of the system. Answer D is incorrect: This would clearly perpetuate the girl's role as the I.P. The correct answer is: build rapport with each family member individually

Object relations is most closely related to: Select one: a. ego psychology b. Adlerian therapy c. psychoanalysis d. Jungian therapy

Object relations theory emphasizes the effects of a young child's relationships with "objects" (significant others) on his/her personality development. Object relations theory is closely related to ego psychology, in that the theory emphasizes the ego as the central structure of the personality. According to object relations theorists, satisfying object relations result in a whole and integrated ego, while frustrating object relations can result in the splitting of the ego.Answer A is CORRECT: See explanation above.Answer B is incorrect: See explanation above.Answer C is incorrect: See explanation above. In his personality theory (which is the basis for classical psychoanalysis), Freud emphasized not only the ego, but also the id and the superego.Answer D is incorrect: See explanation above. The correct answer is: ego psychology

After five sessions of therapy with a family, everyone, including the therapist, agrees that things are worse than when the family started therapy. They describe continual discord at home. The children are trying to get each other in trouble, the parents are arguing, and there is hardly ever laughter at the dinner table. They come in for their sixth session and announce that they have decided to terminate treatment. The therapist should: Select one: a. see them all individually b. reframe this escalation of symptoms as a learning opportunity c. tell them they may need a psychiatrist d. allow them to terminate and end the session right then

One of the main points in this vignette is that a system that is changing frequently experiences more stress than before because its homeostasis has been disrupted. In other words, things often have to get worse before they get better. In this case, the therapist should introduce the idea that change and stress can be positive learning experiences and are not, in themselves, signs that therapy is not working.Answer B is CORRECT: This response addresses the issue at hand.Answer A is incorrect: This family may be working something out. Therefore, separating them at this point is contraindicated.Answer C is incorrect: This is probably not true.Answer D is incorrect: This is playing into the family's resistance to change. The correct answer is: reframe this escalation of symptoms as a learning opportunity

In terms of group therapy, premature termination has been found to depend most on the members': Select one: a. locus of control b. expectations c. psychological mindedness d. diagnosis

One of the most consistent findings of the research on group therapy is that people who terminate prematurely from group treatment are those who have unrealistic expectations and unfavorable attitudes.Answer B is CORRECT: Because of the relationship between unrealistic expectations and premature termination, experts suggest that, to ensure the success of a therapy group, members should be selected through prescreening or should be given some type of pregroup training. Answer A is incorrect: See explanation for response b.Answer C is incorrect: See explanation for response b.Answer A is incorrect: See explanation for response b. The correct answer is: expectations

Which of the following would you be most likely to use if you wanted to reveal aspects of a family's perceptions and feelings? Select one: a. genogram b. empty-chair c. sculpting d. reframing

Only one of the techniques listed is specifically associated with revealing aspect of a family's perceptions and feelings. Answer C is CORRECT: This is the technique you would be most likely to use for this purpose. Sculpting is a psychodramatic technique in which family members position themselves to reveal significant aspects of their perceptions and feelings (e.g., emotional closeness and distance). Answer A is incorrect: A genogram is used to provide the therapist and family with information regarding ongoing patterns of behavior in the family over at least three generations. Answer B is incorrect: The empty chair is used to enable a client to express his/her feelings to a significant person as though the person were in the room. This method is typically used with an individual rather than a family. In addition, rather than being used to reveal "aspects of feelings or perceptions" (e.g., distance vs. closeness), the empty chair is used to facilitate the direct expression of specific, previously unstated feelings to the "person" in the empty chair. Answer D is incorrect: Reframing is used to relabel or redefine a family's description of a behavior to make it more amenable to therapeutic intervention (e.g., a family member's depression may be reframed as laziness). The correct answer is: sculpting

Which of the following describes the goal of the therapeutic method called "prescribing the symptom"? Select one: a. redefining a problem to make the client more open to change b. redefining a problem so that it is no longer seen as pathological c. undermining the client's resistance to change d. taking the focus off of the identified patient in a family

Prescribing the symptom is a paradoxical intervention in which a client is asked to continue or even exaggerate his/her symptomatic behavior in order to undermine his/her resistance to changing the behavior. If the client resists the directive, then the behavior stops; if the client follows it, then the client learns that the behavior is under his/her voluntary control.Answer C is CORRECT: This is correct; see above.Answer A is incorrect: This describes the therapeutic technique known as "reframing."Answer B is incorrect: This is a description of "relabeling."Answer D is incorrect: There are several ways to take the focus of an I.P. but prescribing the symptom is not associated with this goal. This goal is more associated, for example, with relabeling; i.e., the therapist can redefine a presenting symptom in interpersonal terms rather than individual ones (e.g., a family usually come to therapy blaming one member and a therapist can attempt to take the focus off this member by helping the family understand the problem in terms of the whole family system). The correct answer is: undermining the client's resistance to change

The likelihood that an ideal working relationship will develop between a therapist and his or her client appears to depend most on which of the following? Select one: a. the therapist's gender b. the therapist's expectations c. the therapist's theoretical orientation d. the therapist's experience

Research on the effects of therapist factors on therapy outcome have generally yielded inconclusive results.Answer D is CORRECT: According to Bourne and Ekstrand (1985), a therapist's effectiveness in establishing an ideal therapist-client relationship increases as the therapist's experience increases.Answer A is incorrect: The therapist's gender has not been found to be associated in any predictable way with the therapist-client relationship or any other outcome measure.Answer B is incorrect: Research has not found the therapist's expectations to be an important determinant of the therapist-client relationship.Answer C is incorrect: Theoretical orientation seems to be less important than the therapist's experience. The correct answer is: the therapist's experience

A therapist defines meanings in a client's experiences that a client is barely aware of. This therapist is displaying which of the following? Select one: a. genuineness b. congruence c. reactivity d. empathy

Several of the answers are related because they are all parts of Rogers's therapeutic triad and you might have had trouble distinguishing among them. However, only one is correct. Empathy has been defined as "insightful awareness into the meaning and significance of the feelings, emotions, and behavior of another person." Effective empathic responding entails first accurately perceiving the client's expressed or implied feelings or meanings and then communicating this understanding to the client in language that is consistent with what the client is experiencing at that moment. You can respond both verbally and nonverbally to demonstrate your understanding.Answer D is CORRECT: A therapist who defines meaning in a client's immediate experience of which the client is barely aware can be said to be displaying empathy.Answer A is incorrect: Like empathy, this is part of Rogers's therapeutic triad, but it is not what this therapist is displaying. Genuineness occurs when therapists are authentically themselves with their clients and when their words match their gestures and facial expressions.Answer B is incorrect: This is a synonym for genuineness.Answer C is incorrect:This is a distractor in this context. The correct answer is: empathy

Wegscheider and others have labeled roles in the alcoholic family system. Typically, the youngest child in an alcoholic family is the: Select one: a. scapegoat b. hero c. mascot d. lost child

Sharon Wegscheider-Cruse, Sharon Black, Jael Greenleaf, and others have identified roles in the alcoholic family.Answer C is CORRECT: The mascot is typically the youngest child in the family; he/she tends to play the clown to relieve family tension and gain parental attention.Answer A is incorrect: The scapegoat is often the second child in the family; he/she gets the family's attention by developing angry and defiant behavior.Answer B is incorrect: The hero is often the oldest child in the family; this child quickly asserts his/her alliance with the sober spouse and is the "good" child who becomes a stable source of dependability in a chaotic family.Answer D is incorrect: The lost child is typically the third child in the birth order who is quickly overwhelmed by his/her older siblings; he/she "gives up" and tends to withdraw, be a follower, and be isolated both physically and psychologically. The correct answer is: mascot

You are currently treating a large family that presented with communication and discipline problems. You assess the family as having an enmeshed style and a weak executive subsystem. Your overall goal is to define clearer boundaries within the system. Given this context, it is likely that you would agree with all of the following EXCEPT: Select one: a. both the family's present and its past will be examined in therapy b. the focus of treatment should be on changing the family's maladaptive transactional patterns c. dysfunctional patterns in the family can be altered through the use of directive techniques d. the focus should be each family member and on how family members feel about and interact with each other

The assessment and treatment goal with this family is indicative of a structural family therapy approach. You needed to choose the statement that is not true about structural family therapy.Answer D is CORRECT: The key problem with this answer is the word "individual" as the focus of structural family therapy is not on the individual but on triads, coalitions, subsystems, etc. In addition, while the second part of the answer could be true about Structuralists, the emphasis on "feeling" has more of a psychodynamic or experiential/humanistic flavor.Answer A is incorrect: Although the focus of therapy is not on multigenerational issues, as in Bowen's therapy, the structural approach does examine the past and the present; i.e., how the family's present structure is carried over from past transactional patterns. For example, Structuralists are interested in the developmental stages of the family life cycle and in how a particular family can restructure to accomplish developmental tasks.Answer B is incorrect: Structuralists do work to change maladaptive transactional patterns. Structural family therapy works by opening alternative patterns of family interaction in order to modify the family's structure. The therapist helps to activate certain structures, which can then become reinforcing, and to change eventually the structure of the family.Answer C is incorrect: Structural therapists use a number of directive techniques, including reposturing, enacting family transactional patterns ("enactment"), utilizing symptoms, manipulating mood, and escalating stress. The correct answer is: the focus should be each family member and on how family members feel about and interact with each other

A client is late for a session. He has been working on issues of self esteem and self defeating behavior. This is the 5th time he has been late in three months. At this point, you're feeling resentful and you want to tell him. You should: Select one: a. tell him b. not tell him c. be cold to him d. tell him only if you feel he is able to deal with it

The issue of countertransference is important in all therapeutic relationships, regardless of the therapist's orientation. Harboring resentment toward a client can adversely affect the therapeutic relationship. Answer A is CORRECT: This seems like the response that will have the most therapeutic value. Being up front -- i.e., appropriately assertive -- with this client would probably lead to greater trust and also serve as a good model of openness for the client. Answer B is incorrect: If you do not tell the client about your resentment, he might pick up on it through your metacommunication. The client and the therapeutic relationship would benefit from your honesty rather than your deceit. Answer C is incorrect: This passive-aggressive approach will be immediately perceived by your client and could be shaming and hurtful to him. Answer D is incorrect: This issue has already affected the therapeutic relationship and, therefore, needs to be discussed. And, you cannot know the client's ability to "deal with" this issue unless you bring it up. Although he may react with anger or hurt feelings, that can be dealt with in therapy and might lead to his growth. The correct answer is: tell him

Your clients are a black woman and her three children. Mom works two jobs to support the family. In the first session, she tells you that her eleven-year old son, Antonio, has been acting out and having school problems, as well as imitating the bad behavior of his older brother. Also in the session are Antonio's two siblings, a 15-year-old brother, who also has school problems, and a 14-year-old sister, who has no problems in school. During the first session, Antonio takes off out the door. The family all express their frustration and anger at Antonio, but no one takes any action. What would have to happen in therapy in the first session to ensure that the mother returned for the next session? Select one: a. she would have to join with the therapist b. something concrete would have to happen c. Antonio would have to agree to stay in the room d. you would have to lower her fee

The key idea in this case study is the fact that this whole family is your client. Your interventions would, therefore, focus on the family group. Your particular approach would, of course, depend on your theoretical orientation but, in general, a systems approach is called for.Answer B is CORRECT: This places the responsibility on the mother and will immediately establish Mom as the authority in the family. It is clear that her position as the head of the family is not solid, so this will help to reestablish her authority.Answer A is incorrect: This would not deal with the problem.Answer C is incorrect: This could cause trouble in terms of your taking on all the responsibility for bringing the boy back. What if he refuses to comply? Would you engage in a power struggle?Answer D is incorrect: This is not a bad answer but it's not the best one offered: although it does address the problem rather than avoid it and get the family into a problem-solving mode, it doesn't help to reestablish Mom's authority. The correct answer is: something concrete would have to happen

You are a psychodynamic therapist successfully ending long-term therapy with a client. Which of the following is most likely to be going on? Select one: a. An increase in transferential phenomena. b. The client is expressing feelings of sadness at the ending of the therapy. c. The original symptoms will recur. d. Previously unexpressed hostility will surface.

The key word in this question is that therapy was successful.Answer B is CORRECT: Successful therapy often results in a real attachment and the client will be very appropriately processing sadness as the relationship ends.Answer A is incorrect: Successful psychodynamic therapy includes the working through of transferential material.Answer C is incorrect: The return of the original symptoms are unlikely to recur, since presumably the successful therapy has brought the unconscious conflicts underlying those symptoms to awareness.Answer D is incorrect: Hostility is more likely near the beginning of therapy as an expression of resistance. The correct answer is: The client is expressing feelings of sadness at the ending of the therapy.

You are a therapist seeing a family in private practice. Previously, the family was being seen at a low-fee clinic for a long time where the therapist would keep them waiting every time they went to a session. Now that they are your clients, they show a persistent pattern of arriving either 20 minutes early or 20 minutes late. If you, as their current therapist, did not know about the family's history, you would probably view their behavior as: Select one: a. resistance b. using manipulation c. enactment d. anxiety

This is a common sense question for which you had to pick the best of four poor choices.Answer B is CORRECT: This family could be manipulating you by attempting to get extra time, showing up early for their appointment and then alternately showing up late to control your schedule. Answer A is incorrect: If the family were resistant, they would most likely either not show up, cancel at the last minute, or show up late -- not early.Answer C is incorrect: Enactment is a structural therapy technique for simulating in therapy the transactions which make up a family structure.Answer D is incorrect: The family could be demonstrating anxiety, but selecting this requires more of a "leap" than choosing "b" does. In other words, answer "b" is more likely -- the behavior appears to be manipulative since it is a persistent pattern and involves coming both early and late. The correct answer is: using manipulation

A good way to assess whether a family is ready to change is to: Select one: a. review your notes b. do a genogram c. make a sociogram d. talk to your colleagues

This is an ambiguous question, involving more factors than can be addressed here. If you look at the answers, you'll see that you are being asked to choose the best of four poor answers. This may also happen on the MFT examination.Answer A is CORRECT: This is one way a therapist can determine whether a family is ready to change and, compared to the other answers offered, is a more complete source of information. Reviewing your notes is a way of reminding yourself of the information you have on the family, including their reports about their history and current conditions, your observations, the results of any assessment tools you used, and what has happened in therapy to date, including the clients progress and any history of change. With long-term cases, it is especially important to review your notes from time to time, to remind yourself of past events and to use the clients history in your consideration of future changes.Answer B is incorrect: A genogram would provide useful information about historical patterns in the family but is a more limited source of information than your notes on the clients (which might include genogram information). A genogram is typically done in the early stage of treatment, primarily for assessment purposes.Answer C is incorrect:While useful for assessment purposes, a sociogram would be a more limited source of information than your notes on the clients (which would include the sociogram, if you drew one). A sociogram is a graph of a family's current state, or its sociometry, primarily in terms of its boundary relations. When drawing a map, or sociogram, of a family, the therapist depicts his/her perception of the distance or closeness between and among all family members. This, however, is primarily a good assessment tool of the current conditions within the family and would not necessarily aid in determining their readiness to change. Readiness to change involves a number of factors, including past changes and involvement in therapy, which are not addressed by a sociogram.Answer D is incorrect: Consultation with colleagues is important to help you clarify specific treatment issues. However, without reviewing your notes, this strategy would probably not help you much in determining the family's readiness to change. In addition, without access to the data in your notes, your colleagues would be unlikely to have sufficient information to tell you whether or not the family is ready to change. The correct answer is: review your notes

Mary is a 15-year-old who has been truant for 31 days. In addition, her parents report that Mary sleeps all day and stays up most of the night. She has gained 30 pounds over the past six months. She looks sad and has isolated herself from all her friends. A strategic family therapist treating Mary and her family for the first time would most likely: Select one: a. relabel Mary's behavior as stubbornness or laziness b. emphasize in-session enactment c. deal directly with the web of invisible loyalties influencing family members' behaviors d. establish a hierarchy

This is another question which requires you to call on your knowledge of interventions associated with particular theories.Answer A is correct: Relabeling is associated with Strategic family therapy. Relabeling attempts to alter the meaning of a situation by altering its conceptual and/or emotional context in such a way that the entire situation is perceived differently.Enactment is associated with Structural family therapy (B). The intervention in answer C is more clearly associated with Contextual family therapy. Hierarchy is a word associated with Strategic family therapy, but not in this manner. There are many other instances in which hierarchies are used. For instance, in behavioral therapy a hierarchy is established when intervening with systematic desensitization (D). The correct answer is: relabel Mary's behavior as stubbornness or laziness

Bipolar I Disorder is distinguished from Bipolar II Disorder by the presence of which kind of episode? Select one: a. Manic episode b. Psychotic episode c. Mixed episode d. Depressed episode

This is another straightforward recall question about diagnosis.Answer A is correct: The presence of a manic episode rules out Bipolar II Disorder. The criteria for diagnosing Bipolar I Disorder include one or more manic episodes.Answer B is incorrect: With psychotic features is a specifier for Bipolar I Disorder, but psychotic episodes are not one of the types of episodes associated with the Bipolar Disorders. The correct answer is: Manic episode

A family consisting of a mother, son, age 15, and daughter, age 16, comes for therapy. The parents are divorced and the father will not be attending sessions. The son has been suspended from school for possession of marijuana. In the first session, you notice that the son is hostile toward the mother for bringing him to therapy. During the next few sessions, you notice that the mother seems to favor the daughter. The two sit closely together and the mother mentions her daughter's successes and says she is proud of her. She seems to have a hostile attitude toward her son and freely discusses how embarrassed she is that "something like this" could happen. You begin to think that she is projecting her negative feelings about her husband onto her son. How should you interrupt the mother's hostile behavior toward her son? Select one: a. confront it directly with a therapist "I"-message such as "I notice you are extremely angry toward your son and I want you to stop expressing it just for now" b. ask the mother to tell you some more about her ex-husband c. ask the son to speak up and defend himself d. direct a family sculpture exercise to raise the mother's awareness of the boy's position as a scapegoat

This question allowed you to practice your ability to pick out key information from a long case study. Only one of these answers would be appropriate, based on the information in the question.Answer B is CORRECT: This is the best choice. Talking about her ex-husband will automatically deflect Mom's hostility away from her son, and she or other family members may even see for themselves the similarity between her feelings for her ex-husband and her feelings for her son.Answer A is incorrect: Confronting Mom directly would be extremely threatening to her and would probably interrupt her hostile behavior only temporarily.Answer C is incorrect: Based on the information we have, it appears that the son probably isn't able to defend himself adequately.Answer D is incorrect: Even though this is less direct than answer "a," confronting Mom by directing a sculpture would also be threatening to her and would probably interrupt her hostile behavior only temporarily. The correct answer is: ask the mother to tell you some more about her ex-husband

Studies investigating the relationship between maternal socialization practices and children's internalization of conscience have found that: Select one: a. maternal gentle discipline is predictive of internalization regardless of a child's temperament b. maternal gentle discipline is predictive of internalization only for children who have a secure attachment c. maternal gentle discipline is predictive of internalization for children who are fearful and anxious prone d. maternal gentle discipline is predictive of internalization for children who are relatively fearless and non-anxious

This question is asking about research by G. Kochanska, which found that the relationship between maternal parenting style and children's internalization of conscience is mediated by the child's temperament. (Socialization and temperament in the development of guilt and conscience, Child Development, 1991, 62, 1379-1392).Answer C is CORRECT: The impact of gentle discipline (use of control that de-emphasizes power assertion and emphasizes reasoning, suggestion, distraction, and positive reinforcement) is most effective in terms of internalization for children who are relatively fearful and anxious.Answer A is incorrect: See explanation for response c.Answer B is incorrect: See explanation for response c.Answer D is incorrect: For children who are fearless and non-anxious, a secure attachment seems to be more important than maternal parenting style for internalization of conscience. The correct answer is: maternal gentle discipline is predictive of internalization for children who are fearful and anxious prone

During your second session with a client, she tells you that she had a sexual relationship with her former therapist. She says that she is embarrassed and just wants to forget the whole thing but that she still has feelings for the therapist. The client also says that she's told you this because she trusts you, but she knows that therapists "stick together" and that you probably won't do anything. Your ethical obligation in this situation is to: Select one: a. call the other therapist to find out his side of the story. b. inform the client of her legal rights and options. c. report the therapist to the licensing board. d. collect additional information about the matter in subsequent sessions.

This question is asking what you are ethically obligated to do when you learn of an ethical violation by a colleague that involves one of your current clients.Answer B is correct: The AAMFT Code of Ethics doesn't directly address this type of situation, but this answer is most consistent with the "spirit" of the Code and with the requirement of Standard 1.8 to "respect the rights of clients to make decisions and help them to understand the consequences of these decisions." Answer A is incorrect: Calling the therapist without the client's authorization would constitute a breach of client confidentiality. Answer C is incorrect: This would also constitute a breach of client confidentiality. Answer D is incorrect: This issue is serious enough to warrant an immediate response from you and, as noted above, informing the client of her legal rights and options would be the best action. The correct answer is: inform the client of her legal rights and options

The parents of 6-year-old Anna bring her to therapy. They are very concerned because she has recently been caught stealing money from her mother's purse and has brought home items from school that they know are not hers. When they ask Anna to explain, her answers are not satisfactory. She claims, for example, that she does not know how her mother's money appeared in her pocket. Useful interventions might include: Select one: a. referral to a pediatrician for evaluation b. normalizing the process for the parents, for example, by explaining that many 6-year-old children have an unclear notion of causality c. referral for psychological testing d. consultation with the child's teacher

This question is difficult because it says "useful interventions might" include. In spite of this wording, your job was to choose the best, or most important, intervention. Keep in mind Anna's age -- six -- and that her behavior is not all that atypical.Answer D is CORRECT: Since Anna's stealing has occurred at school as well as at home, and the teacher is someone who has had extensive, daily contact with Anna over a period of time, he or she would be an obvious resource for collecting useful information.Answer A is incorrect: This is a possibility if you assume that Anna cannot explain her stealing because she is disoriented or confused, but that's a big leap. While it is important to explore the potential role of a medical condition or other physiological effects when making a diagnosis, there is no indication of a physiological basis for stealing behavior.Answer B is incorrect: Many children steal occasionally, especially when there is anxiety or tension at home. However, stealing is really not "normal" and reassuring the parents in this way might discourage them from continuing treatment. In addition, the developmental explanation about causality is actually more valid about children younger than Anna, in what Piaget calls the preoperational stage (ages 2-7). Actually, it would be the preconceptual substage which begins around the age of two.Answer C is incorrect: It often is interesting to know the results of psychological testing, but there is no clear indication about what you'd be expecting to find in this case. The correct answer is: consultation with the child's teacher

Which of the following would be most effective for successful treatment of Premature Ejaculation? Select one: a. stop-start technique plus dealing with the resistances of the partners b. teaching the man to use the squeeze technique c. ejaculatory abstinence d. interviews and sensate focus

This question might have been difficult because more than one of the answers suggests a technique used to treat Premature Ejaculation. However, one answer is more complete than the others.Answer A is correct: This is the most complete answer. Kaplan recommends use of the stop-start technique and psychotherapy to deal with the resistances of both partners.Answer B is incorrect: This is recommended by Masters and Johnson, but is done by the partner.Answer C is incorrect: This is used to treat impotence.Answer D is incorrect: This is one step in Masters and Johnson's treatment for Premature Ejaculation; however, since their treatment involves so much more than this, Answer A is a better answer. The correct answer is: stop-start technique plus dealing with the resistances of the partners

All of the following are true about a behavioral approach to therapy except: Select one: a. behaviorists prefer observation over introspection b. behaviorists believe that a client's symptoms are merely observable behaviors that have been labeled as problematic c. behavioral interventions are intended to modify only certain, limited aspects of human behavior d. under certain conditions, behaviorists are concerned with affect and cognitions

This question primarily tests your knowledge of behavior modification but it also helped if you understand the assumptions underlying behavioral therapy. You needed to choose the statement that is not true.Answer C is CORRECT: Contrary to what this response says, the emphasis of the behavior modification approach is not just on narrow aspects of human behavior. Instead, the target of behavioral techniques is on all behaviors as long as those behaviors are observable.Answer A is incorrect: This is an axiomatic principle of behaviorist approaches.Answer B is incorrect: This is an axiomatic principle of behaviorist approaches.Answer D is incorrect: This response is tempting, however, inner states such as affect and thought are not explicitly denied by behaviorists. They would consider such states to be relevant if they can be made observable through scientific measurement. The correct answer is: behavioral interventions are intended to modify only certain, limited aspects of human behavior

Satir has identified which of the following styles of communicating? Select one: a. rescuing, agreeing, disagreeing, distracting, growing b. digital, analogic, symmetrical, complementary c. placating, blaming, discounting, invalidating, leveling d. placating, blaming, computing, distracting, leveling

This was a straightforward "recall" question, but it might have been difficult since many of the terms in the answers are associated with Satir's communication styles and family games.Answer D is CORRECT: Satir identifies four dysfunctional styles of communicating (placating, blaming, computing, distracting) and one functional style (leveling).Answer A is incorrect: See explanation for answer "d."Answer B is incorrect: See explanation for answer "d."Answer C is incorrect: See explanation for answer "d." The correct answer is: placating, blaming, computing, distracting, leveling

Your client is a 10-year-old boy who is defiant and inattentive. Your best intervention would be: Select one: a. to make him talk to you b. to sit on the floor with him c. to offer to play checkers or some other game he knows d. to ask about his favorite music and listen to it with him

Three of the interventions involve attempting to connect with the boy, which is a good idea.Answer D is CORRECT: Because listening to music is an activity that involves no competition, it is perhaps a better way of joining a defiant child than playing a game with winners and losers.Answer A is incorrect: "Making" him talk is probably impossible and would just feed into the dynamic of defiance.Answer B is incorrect: Be sure to read carefully: just "sitting on the floor with him" doesn't suggest as active a connection as "c" or "d." Had this response suggested that you would play with the boy while on the floor, with the toys he chooses, it would have been correct.Answer C is incorrect: Playing a competitive game may encourage more defiance and inattentiveness. The correct answer is: to ask about his favorite music and listen to it with him

A wife says to her husband, "I'll keep the house clean and look after the children if you provide the family with financial support." According to Don Jackson, this is an example of which of the following? Select one: a. symmetrical quid pro quo marital arrangement b. complementary quid pro quo marital arrangement c. parallel quid pro quo marital arrangement d. dysfunctional marital arrangement

To identify the correct answer, you needed to apply your knowledge regarding Jackson's theory to the arrangement in the question. According to Jackson, relationships and communications are either symmetrical or complementary. Symmetrical exchanges are between equals and may lead to difficulties with competition and escalation. Complementary exchanges are based on different levels of relating that fit together. Jackson also described marital complementarity in terms of a "quid pro quo" rule. Quid pro quo literally means something that is given or received for something else. When applied to family systems, this rule refers to the foundation of a relationship where something is required of a person in exchange for what is given by the other. The rules of the quid pro quo may be implicit or explicit and, when they are formalized, as in this case, the couple is said to have a marital contract.Answer B is CORRECT: This case illustrates a complementary quid pro quo marital arrangement. See above.Answer A is incorrect: Although quid pro quo is right, symmetrical is not. See above.Answer C is incorrect: Although quid pro quo is right, you can't know if parallel is right or not. In parallel relationships, the partners alternate comfortably between complementary and symmetrical relationships as they adjust to changing situations.Answer D is incorrect: This is not a term associated with Jackson. The correct answer is: complementary quid pro quo marital arrangement

In structural family therapy, the therapist's attempts to identify and then use a family's symbols, styles, and values in therapy in order to more effectively influence the family is referred to as: Select one: a. tracking b. reframing c. prescribing d. enactment

Tracking is described in this question. This is a technique in which a therapist follows the content of a family's communication, using minimal encouragers and restating what the family has said. The use of tracking confirms the family by valuing what the members say and often elicits information and permits the therapist to identify and assess the family's structure. You might have had to think a bit to choose this answer, however, because reframing and enactment are also associated with structural family therapy. Answer A is CORRECT: This is the right answer. See above. Answer B is Incorrect: Reframing involves relabeling a family's description of a behavior in order to make it more amenable to therapeutic intervention. It not only calls the symptom something different but also changes the context in which the family perceives it (e.g., defines it as something positive or benign, rather than negative or harmful). Answer C is Incorrect:"Prescribing" is vague but may refer to "prescribing the symptom," which is a paradoxical intervention that forces the patient to either give up a symptom or admit that it is under his/her voluntary control. It could involve, for example, telling an overprotective mother to take better care of her child. Answer D is Incorrect: Enactment involves a simulation of the transactions that make up a family's structure (e.g., asking a family to act out a recent conflict), followed by efforts to change them. The correct answer is: tracking

A young man comes to you requesting therapy for "interpersonal difficulties" at work. You learn that he has a history of offenses that you find difficult to deal with and, therefore, you feel that you would not like working with him. As an ethical therapist, you should: Select one: a. disregard your personal preferences and accept the young man into treatment. b. refer the young man to another professional. c. accept the young man into therapy but seek supervision. d. tell the young man you cannot accept him into therapy and do not charge him for the session.

When a therapist believes that some characteristic of a client would interfere with the development of the therapeutic alliance, it would not benefit the client to continue treatment because this alliance is considered to be a crucial factor in therapy outcome.Answer B is correct: It isn't a violation of the ethical principles to not accept a client into treatment when the therapist feels that he/she would be unable to form a therapeutic relationship with the client. Therefore, the most ethical course of action would be to refer the client to another professional. Doing so is consistent with the requirement of Standard 1.10 to make appropriate referrals when one is "unable or unwilling to provide professional help." Answer A is incorrect: It is unethical for a marital and family therapist to accept a client into therapy if the therapist's personal preferences may negatively effect the therapeutic process.Answer C is incorrect: Supervision may not be adequate to overcome the personal preferences of the therapist, so answer "b" better safeguards the client's welfare and is a better answer.Answer D is incorrect: Termination without providing referrals is not the best course of actions. You would want to help the client find other therapeutic services. The correct answer is: refer the young man to another professional.

When providing therapy to a racially or culturally different client, you should: Select one: a. discuss the difference only if the client raises concerns about it. b. rely on generalizations about the client's racial or cultural group to maximize the effectiveness of therapy. c. ask the client if he or she has any concerns about the difference during an initial session. d. be aware that a client's experiences with prejudice may take the form of paranoia and pathological defensiveness.

When working with clients who differ from you in terms of race, culture, or other important characteristic, the best approach is to address the difference with them in an initial session.Answer C is correct: As noted above, this is the best strategy. Answer A is incorrect: Waiting for the client to raise the issue is not usually the best strategy since the client may feel uncomfortable addressing it. It's better to acknowledge the difference and identify and discuss any concerns the client has. Answer B is incorrect: Although generalizations may be a good starting point, it is always important not to rely too much on generalizations and, instead, focus on understanding the individual client. Answer D is incorrect: Members of some racial/cultural groups may have experienced prejudice because of their group membership, and resistance in therapy may reflect a realistic response to past experiences rather than "paranoia and pathological defensiveness." The correct answer is: ask the client if he or she has any concerns about the difference during an initial session.

Marissa is 23 and has come to you because she is finding it difficult to care about her graduate work in accounting, her job, or her hobbies of tennis and sailing. In addition, she complains that she is feeling real despair for the first time in her life. She is irritable with friends and is having trouble sleeping. She does state, however, that she is happy she has lost her appetite. She has felt this way for three weeks. Your first action with the client would be which of the following? Select one: a. consultation with a physician b. assessment of her potential for suicide c. contacting her family d. behavioral therapy to relieve her depression

You were asked to identify your first action. Answer B is correct: The client's feelings of despair suggest that the first intervention should be an assessment of potential for suicide. Answer A is incorrect: Note that this suggests "consultation" with a physician. Had this suggested referral for a medical evaluation, it would also have been an important first step. Answer C is incorrect: If you assessed that Marissa's potential for suicide was high, you could contact her family to enlist their help in protecting her from a suicide attempt, and you could do this without Marissa's permission if necessary. Before you have performed a suicide assessment, however, this action, without prior written permission from Marissa, would represent an unethical breach of her confidentiality. (You might, alternatively, have interpreted "contacting her family" as suggesting a means of collecting collateral information for your assessment; here too, however you would need to get Marissa's written permission beforehand in order to avoid an unethical breach of confidentiality.) Answer D is incorrect: This might be effective later but it certainly isn't the best first step, as it ignores the possibility that this client might be suicidal. The correct answer is: assessment of her potential for suicide