MFT 180 Pratice Exam

Brief therapy is a time-limited, pragmatic, non-historical strategic approach to difficulties in a person's life. Brief therapy models focus primarily on: Select one: a. First order change. b. Second order change. c. Therapist neutrality. d. Client insight into his/her role in problem maintenance.

Answer A is correct: Brief therapy tends to focus on specific behavioral goals, or first order changes. First order changes are symptomatic, not changes to the fundamental dynamics of the family system. Second order change is the longer-term systemic change that happens after the more concrete first order changes occur (B). Therapeutic neutrality is not a brief therapist's style. Brief therapists are active and usually directive to some degree (C). Client insight into his/her role in problem maintenance is one of the focuses of the psychodynamically oriented brief therapies, but the insight is more directed to the problem's origin, rather than only on behavior or first order changes (D). The correct answer is: First order change.

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.

As described in the DSM-5, the characteristic symptoms of Substance Use Disorder can be categorized in terms of which of the following? Select one: a. Impaired control, social impairment, risky use, and pharmacological criteria b. Functional impairment, denial of consequences, impaired control, and pharmacological criteria c. Impaired control, tolerance, withdrawal, and functional impairment d. Functional impairment, tolerance and withdrawal, risky use, and marked distress

Answer A is correct: The DSM-5 categorizes the indicators of problematic substance use in terms of the four categories listed in this answer. Impaired control refers to the tendency of the individual to use more of the substance than intended, inability to cut down on substance use, craving for the substance, and tendency to spend a great deal of time obtaining, using, or recovering from the effects of the substance. Social impairment refers to difficulties with social, occupational, and/or recreational activities due to the substance use. Risky use refers to use of the substance in situations that are potentially physically hazardous or despite knowing that physical or psychological problems may be exacerbated by substance use. Pharmacological criteria are tolerance and withdrawal. The correct answer is: Impaired control, social impairment, risky use, and pharmacological criteria

A woman comes to counseling because of problems she is having in her marriage. She explains that she is overly emotional about things and takes things too personally. She tells you that her husband is constantly telling her that she lets her emotions get the best of her and that she's just "too weak." From a feminist perspective, therapy would focus on all of the following, EXCEPT: Select one: a. Validation of feelings and experiences. b. Exploration of the detrimental impact of egalitarian relationships. c. Recognizing that the personal is political. d. Focus on power differentials and how power can be exercised.

Answer B is correct: Feminist therapy focuses on the development, not the detrimental impact, of egalitarian (or equal) relationships. This starts within the therapeutic relationship, wherein the therapist and client are considered equals. In feminist therapy, a client's feelings and experiences are always validated (A). Feminist therapists believe that the personal is political. This means that many of the personal problems women experience in their lives are not their fault but are the result of systematic oppression (C). Feminist therapists focus on power differentials and the ways in which power can be utilized (both positively and negatively) in relationships (D). The correct answer is: Exploration of the detrimental impact of egalitarian relationships.

A Structural therapist begins treatment with the Miller family. The 15-year-old son has been using crystal meth for the past 3 months. His school performance has rapidly deteriorated, and recently he was picked up for truancy. His mother is in tears as she describes what a "perfect child" he once was. His father laughs with disgust and says his son was always a "mama's boy" and that it serves her right for coddling him for so many years. The father tells the therapist that he has no intention of continuing treatment as this is his son's problem, not his. How should the therapist proceed? Select one: a. Explain to the father that his son's behavior is a problem within the family system and that he must participate in therapy in order for change to occur. b. Tell the dad how much the therapist admires and respects his clarity. c. Agree to see just the mother and son. d. Refer the family to a therapist whose orientation better suits this family.

Answer B is correct: Telling the dad how much the therapist admires and respects his clarity is the best of the answers provided. Joining with the family early on in treatment is critical. Structural therapists create an alliance with the most powerful member(s) of the system. Without the dad's involvement in treatment, effective change cannot occur. Although the idea that the son's behavior is a reaction to a problem within the family system is true, attempting to join (i.e. empathize) with him should be attempted first (A). Structural therapists treat the entire family system (C). It is not necessary to refer the client out yet. Resistance to treatment is a common obstacle. Overcoming this obstacle early on by joining with the family is an integral part of treatment (D). The correct answer is: Tell the dad how much the therapist admires and respects his clarity.

A new client tells the clinician that she's been feeling "down in the dumps" and "completely worthless" for the last five or six days. She also says she's having trouble sleeping, has lost her appetite and feels anxious "all the time." The client denies having previous mood problems and states that there are no particular stressors in her life. The client's symptoms are most suggestive of which of the following DSM-5 diagnoses? Select one: a. Major Depressive Disorder b. Other Specified Depressive Disorder c. Other Specified Anxiety Disorder d. Major Depressive Episode, single episode

Answer B is correct: This client has symptoms of Major Depressive Disorder, but they have persisted for less than two weeks which is the minimum duration required for the diagnosis. Consequently, a diagnosis of Other Specified Depressive Disorder with the reason "short-duration depressive episode" is the best fit for her symptoms. Answer A is incorrect: A diagnosis of Major Depressive Disorder requires a duration of symptoms of at least two weeks. Answer C is incorrect: Although the client is experiencing anxiety, her symptoms do not meet the criteria for an anxiety disorder. Also, the DSM-5 states that "anxious distress has been noted as a prominent feature of both bipolar and major depressive disorder" (p. 184), and the client is exhibiting several symptoms that are typical of major depressive disorder. Answer D is incorrect: Major depressive episode is not a DSM-5 diagnosis but, instead, is an essential feature of Major Depressive Disorder and Bipolar II Disorder and a possible feature of Bipolar I Disorder. The correct answer is: Other Specified Depressive Disorder

Mildred W. has been seeing a therapist for six years for severe, recurrent depression. During today's session, Mildred says that, for the last week, she has felt much better and will no longer need to come to therapy. Mildred thanks the therapist for all the help, and says she hopes she won't be forgotten. The therapist should respond in saying to Mildred: Select one: a. I wonder if you might be interested in another session or two for us to have proper time to talk about our work together and to say goodbye. b. That the sudden shift in mood could represent a "flight to health" and that the two of them should discuss more fully Mildred's decision to terminate. c. Are you thinking about killing yourself? d. I'm delighted that you're doing better, and I won't forget you or the important work we've done together. I wish you well in your future and you can always contact me if you need help again.

Answer C is correct: Mildred's sudden shift in mood and desire to suddenly stop therapy, coupled with a goodbye that sounds final, indicates, for purposes of the exam, a client who is thinking about suicide. Asking direct questions is the best response. Asking about a termination session could be a reasonable response; however, it does not address the sudden shift in mood and sudden decision to terminate therapy, both of which are red flags, for purposes of the exam, for suicide (A). Asking for more time to review the decision to terminate is also a reasonable response, except that, as with Answer Choice A, it also doesn't address the sudden shift in mood and sudden decision to terminate therapy, which are red flags (B). A decision to allow Mildred to walk away from therapy so quickly, without consideration of the possible meanings of her sudden shift in mood and sudden decision to terminate, would not be the best course (D). The correct answer is: Are you thinking about killing yourself?

As described in the DSM-5, the five core symptoms of the Schizophrenia Spectrum Disorders are: Select one: a. Delusions, hallucinations, negative symptoms, impaired cognition, and disorganized speech. b. Disorganized thinking, delusions, hallucinations, negative symptoms, and depersonalization or derealization. c. Hallucinations, negative symptoms, grossly disorganized or abnormal motor behavior, delusions, and disorganized thinking. d. Grossly disorganized or abnormal motor behavior, hallucinations, negative symptoms, affective instability, and delusions.

Answer C is correct: Hallucinations, negative symptoms (e.g., diminished emotional expression, avolition), grossly disorganized or abnormal motor behavior, delusions, and disorganized thinking are the five core symptoms of Schizophrenia and other Schizophrenia Spectrum Disorders. Answer A is incorrect: Impaired cognition is an associated feature of Schizophrenia but is not one of the five core symptoms of the Schizophrenia Spectrum Disorders. Answer B is incorrect: Depersonalization and derealization are associated symptoms of Schizophrenia but are not the core symptoms of the Schizophrenia Spectrum Disorders. Answer D is incorrect: Affective instability is characteristic of Schizoaffective Disorder, which has the same symptoms as Schizophrenia with the addition of a disturbance in mood. The correct answer is: Hallucinations, negative symptoms, grossly disorganized or abnormal motor behavior, delusions, and disorganized thinking.

Common indicators of sexual, physical, and emotional abuse include all of the following features EXCEPT: Select one: a. Violence against younger children b. Sexualized behavior c. Isolation d. Stuttering

Answer D is Correct: Stuttering is not a common indicator of child abuse; therefore Answer D is the correct answer. Violence against younger children (A), sexualized behavior (B), and isolation (C) are indicative of sexual, physical, and emotional abuse. The correct answer is: Stuttering

s a Bowenian family systems therapist, what would be an important intervention in the early stage of treatment with a couple contemplating divorce? Select one: a. Detriangulating. b. Teaching communication skills. c. Helping them reconnect with their families-of-origin. d. Helping each person identify his/her hot buttons and learn how to think before acting.

Answer D is correct: Before the couple can learn to communicate better, they need to be able to reduce emotional reactivity. Identifying hot buttons and thinking things through before emotionally reacting need to occur first. Detriangulating is an important middle stage intervention (A). Teaching communication skills is an important early and middle stage intervention but answer choice D is a better choice for an early intervention (B). Helping the couple reconnect with their families-of-origin is a late stage Bowenian intervention (C). The correct answer is: Helping each person identify his/her hot buttons and learn how to think before acting.

A therapist insists that Mr. and Mrs. Terrace sit together on one cushion of the couch, while the kids. play on the other side of the room. Whenever the children come over and attempt to get their parents' attention the therapist says, "I see you really care about your parents and want to be around them a lot," and then turns to their parents and says, "You shouldn't let your children interfere with your private time so often." This is a structural example of: Select one: a. Confirmation. b. Intensity. c. Boundary marking. d. A stroke and a kick.

Answer D is correct: This is an example of a stroke and a kick. A 'stroke and a kick' is a Structural term for acknowledging one member of a system for positive intent, while pointing out to another member of a system how the action has a negative impact on her/him. Confirmation is a structural term that entails pointing out strengths in an individual or family system (A). Intensity is a structural term referring to using a change in your tone of voice or repeating yourself to emphasize a point in session (B). Boundary marking is a structural intervention designed to separate and strengthen subsystems and break unhealthy alliances. For example, if the therapist redirected the children to go back to the other side of the room to play each time they came near the couch, that would be considered boundary marking (C). The correct answer is: A stroke and a kick.

In preparing a client for termination of therapy, the BEST approach would be to: Select one: a. Discuss and stick to a set number of sessions so the client knows what to expect. b. Allow enough time to explain to the client why you think termination is indicated. c. Have advance knowledge of limitations and exclusions in the client's insurance plan to sufficiently prepare her/him. d. Explore with the client under what circumstances s/he would feel ready to terminate.

Answer D is correct: Ultimately, it is important to collaboratively explore the conditions for termination with the client. This allows the therapist to address the client's needs and make adjustments in the termination plan as necessary. Creating a one size fits all number of sessions does not allow for the individuality of each client such as his/her symptoms and problems. This would not be the best way to approach termination (A). Allowing enough time to discuss with the client why YOU think termination is indicated does not allow for input from the client (B). Having knowledge of exclusions and limitations of someone's insurance plan is important but should not be how we determine IF the client needs more sessions or IF they should terminate. If a client is out of sessions, it would be ethical to advocate for more or consider self-pay or sliding scale options (C). The correct answer is: Explore with the client under what circumstances s/he would feel ready to terminate.

During an initial interview with a patient who was recently admitted to the hospital, a therapist finds that the patient tends to take an unusually long time to answer questions because he spends a lot of time providing minute details and making parenthetical comments. However, the patient doesn't seem to lose track of the point he is trying to make and usually ends up answering the questions. The man's speech pattern is best described by which of the following terms? Select one: a. Loosening of associations b. Circumstantiality c. Confabulation d. Flight of ideas

Feedback A key feature of this person's speech is that he does not lose the original point.Answer B is correct: The man's speech pattern illustrates circumstantiality. His speech wanders somewhat but he continues to be aware of the original point.Answer A is incorrect: Loosening of associations involves incoherent, rambling speech and loss of the original point.Answer C is incorrect: Confabulation involves the fabrication of details or events in order to fill in information gaps resulting from memory loss.Answer D is incorrect: Flight of ideas involves a nearly continuous flow of rapid speech with abrupt changes from one topic to another. The correct answer is: Circumstantiality

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

Feedback 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

From a systems perspective, which of the following is most true about treating a family with an alcoholic member? Select one: a. the first step in restructuring the family involves getting the alcoholic's relatives to admit that they are codependent b. the aim of therapy is to restructure the family's homeostatic mechanisms c. therapy should focus on identifying and correcting faulty communication patterns in the family d. the family should be trained in ways of reinforcing non-drinking behaviors in the alcoholic and extinguishing drinking behaviors

Feedback Although more than one of these approaches can be used when working with an alcoholic family, the question asked you to focus on a systems approach. According to systems theory, substance addiction is a homeostatic mechanism; i.e., the addict's behavior serves to maintain a sense of balance in the family. When the homeostasis is disrupted, the other members of the system attempt to restore it by engaging in various activities to maintain or restore the alcoholic's addictive behavior. The hope is that when homeostatic mechanisms are changed, the family will reinforce non-drinking behaviors; however, systems therapy doesn't focus only on training the family to engage in certain behaviors; it also emphasizes changing the mechanisms that lead family members to support the alcoholic's drinking and/or sabotage his/her recovery (i.e., the mechanisms that work to restore homeostasis). Often, the first step in treatment is to attain abstinence by the alcoholic family member.Answer B is CORRECT: As indicated above, this describes a systems approach to treating an alcoholic family.Answer A is incorrect: Although intervention with alcoholic families often involves providing education about codependency, it is not necessary for family members to "admit" that they are codependent before treatment can proceed.Answer C is incorrect: This is characteristic of a communications theorist's intervention.Answer D is incorrect: This illustrates a behavioral therapist's intervention. The correct answer is: the aim of therapy is to restructure the family's homeostatic mechanisms

The hallmark concept emphasized in Contextual Family Therapy is: Select one: a. The promotion of an ethical environment in the family. b. Creating a positive emotional context in the family. c. The integration of individual, interpersonal and systemic approaches to family therapy. d. That human beings thrive best in a supportive context.

Feedback Answer A is CORRECT: All of the answers given here are essentially correct in that they are in line with Contextual Family Therapy (developed by Ivan Boszormenyi-Nagy) concepts. However, the primary concept associated with CFT is that an ethical family environment is essential to the healthy emotional and relational well-being of its members. An ethical family environment is one in which trust, mutual support, fairness, accountability and loyalty are present, which creates a positive emotional context for human growth.Answer B is incorrect: Be careful about choosing an answer simply because it has a "buzzword" that you may recognize, such as "context," as in this case. The core meaning of the correct answer, regardless of whether it uses buzzwords, is what makes a good answer. The hallmark concept of CFT is that an ethical family environment creates a positive emotional context.Answer C is incorrect: While it is true that CFT integrates individual, interpersonal and systemic approaches to family therapy, this is not a "hallmark concept," rather it is a statement of fact describing the theory.Answer D is incorrect: While this is a statement that is certainly consistent with CFT, a supportive family context is created when the family system is an ethical one. The correct answer is: The promotion of an ethical environment in the family.

When should the therapist begin discussing termination? Select one: a. At the beginning of therapy b. During formulation of the treatment plan c. Mid-way through the therapy d. Before the termination process begins

Feedback Answer A is CORRECT: Discussing termination at the beginning of therapy builds in the expectation that the client will get better. It also is a good way to begin defining goals - when the client has achieved certain goals, or has become adept at handling certain issues, therapy will no longer be necessary. Also, some clients may be anxious about becoming dependent on the therapist, or be afraid that therapy will go on indefinitely, so discussing an end point to therapy early on may be helpful to them.Answer B is incorrect: While discussing termination in relationship to achieving goals outlined in the treatment plan is helpful, the question asks when should the therapist begin discussing termination (see rationale for "a.").Answer C is incorrect: See rationale for "a."Answer D is incorrect: See rationale for "a." The correct answer is: At the beginning of therapy

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

Feedback 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

Tamara, age 19, is eight months pregnant. She comes into session smelling of alcohol and marijuana. She begins crying and tells you that she just had another fight with her boyfriend. She says she was so upset that she had to smoke a bowl of marijuana in order to calm herself down. You should: Select one: a. Reiterate your 24-hour sobriety policy, make sure Tamara has a safe way home, and reschedule the session for when she is sober. b. Create a safety plan and advise Tamara to go to a shelter for domestic violence. c. File a child abuse report by phone as soon as possible. d. Empathize with the difficult time your client is having, address better ways of coping with the situation, and set goals to abstain from alcohol and drugs for the remainder of the pregnancy.

Feedback Answer A is correct: You would want to make sure that your client has a safe way home and reschedule the session, as the client is intoxicated. Creating a safety plan is not necessary at this point because the vignette does not state that domestic violence has occurred (B). You do not need to file a child abuse report because the client is pregnant; fetal abuse is not a mandated report (C). You would not continue the session if the client is intoxicated (D). The correct answer is: Reiterate your 24-hour sobriety policy, make sure Tamara has a safe way home, and reschedule the session for when she is sober.

Bill, a 32-year-old fireman, was referred to therapy by his EAP. Several months ago, he lost one of his co-workers in a fire. Bill can't shake the feeling that he is responsible for his co-worker's death. He states, "I should have tried harder to save him." Bill has become withdrawn in his marriage and other relationships. He is having difficulty functioning at work. As a cognitive-behavioral therapist, you MOST likely think Bill's problems are a result of: Select one: a.A distortion of reality based on incorrect premises and assumptions. b.Chronic anxiety leading to a high level of emotional reactivity. c.An exaggerated feeling of inferiority and an insufficiently developed feeling of community. d.An inability to experience contradictory feelings leading to a distortion of perception.

Feedback Answer A is correct: According to cognitive-behavioral therapy, Bill's psychological problems are a result of a distortion of reality based on incorrect premises and assumptions, i.e., Bill's belief that he is somehow responsible. Chronic anxiety leading to a high level of emotional reactivity is a Bowenian concept (B). An exaggerated feeling of inferiority and an insufficiently developed feeling of community is an Adlerian concept (C). An inability to experience contradictory feelings leading to a distortion of perception describes the object-relations concept of splitting (D). The correct answer is:A distortion of reality based on incorrect premises and assumptions.

Charles and Martha bring their two children to therapy. The parents are concerned with how disrespectful the youngest child is to the mother. Whenever she tries to discipline him, he engages in name-calling and has threatened violence. The therapist asks the mother to recall a recent event that occurred and notes that the husband rolls his eyes and looks away as she begins to speak. When the therapist calls attention to the husband's response, the youngest child immediately lashes out at his mother. A structural therapist would view this interaction as: Select one: a. Conflict-detouring. b. Reciprocal inhibition. c. Equifinality. d. Nonsummativity.

Feedback Answer A is correct: Conflict-detouring occurs when conflict from one subsystem is detoured to another subsystem. This is often what is occurring in situations where there is a family scapegoat. Reciprocal inhibition is a Behavioral Family therapy term that describes the pairing of responses that are incompatible with anxiety to the previously anxiety-producing stimuli (e.g. systematic desensitization) (B). Equifinality means that the same results may arise from different origins. For example, an inhibited child may develop from experiences of physical abuse or emotional abuse (C). Nonsummativity is the concept that a system cannot by analyzed by isolated segments: "The whole is greater than the sum of its parts" (D). The correct answer is: Conflict-detouring.

n Collaborative Family Therapy, the therapist is generally viewed as: Select one: a. the expert on the therapeutic process. b. a co-learner along with the client. c. an ethical partner in the therapeutic process. d. part of the reflecting team with the client.

Feedback Answer B is CORRECT: The Collaborative approach pioneered by Harlene Anderson and Harry Goolishian, among others, views therapist and client as "conversational partners" who engage in "dialogical conversation" to explore the client's problems. The therapist takes a position as "co-learner" with the client in order to understand the client and their unique perspective. The therapist's stance is of "not knowing" and considers the client as the "expert" on their own life, and as the therapist's "teacher." The therapist's expertise lies in his ability to create the kinds of conversations and experiences that pull forth the client's inner resourcefulness and wisdom.Answer A is incorrect: See answer "b." Answer C is incorrect: All therapists should behave ethically; however, this is not a key concept from Collaborative Family Therapy. Answer D is incorrect:Collaborative therapists often collaborate with one another, and may work in "reflecting teams" to better understand their work with clients. They do not work on a reflecting team with the client. The correct answer is: a co-learner along with the client.

Cindy and Tom Thomas come to counseling with their 6-year-old son, Michael, who was adopted from a Romanian orphanage three years ago. Michael has been slow to learn English, is behind at school, and often doesn't seem focused or socially engaged. Cindy and Tom tell you they often fight about Michael and Tom says, "I think that Cindy spoils him and now he doesn't want to do anything himself." Your next step would be to: Select one: a. Refer Michael for psychological and psychiatric testing. b. Refer Cindy and Tom to a parenting class. c. Normalize Michael's cultural adjustment process. d. Get a release to speak with his teacher.

Feedback Answer A is correct: It is important to refer Michael for a psychological and psychiatric evaluation. Because Michael's prenatal and first three years of care are questionable, it cannot be assumed that his problems are acculturation issues or weak parenting. In recent years there have been many couples who have been stunned to find children who were adopted from abroad were not properly cared for during their formative years and permanent cognitive deficits have been the result. Russian and Romanian adoptions have been under specific scrutiny in this regard. Referring Cindy and Tom to a parenting class would not address any possible existing organic or psychological problems. Because Michael's prenatal and first three years of care are questionable, it cannot be assumed that his problems are strictly the result of trial and error parenting attempts (B). Helping to normalize Michael's bicultural adjustment for his parents is not enough in this case (C). Getting a release to speak with Michael's teacher might be somewhat helpful, but it doesn't address the possible organic problems this child may be having as a result of prenatal or early neglect or abuse (D). The correct answer is: Refer Michael for psychological and psychiatric testing.

During her first session, Jane, age 43, tells the clinician that she needs to work on anxiety and relationship issues. She says she divorced her second husband 11 months ago and has been dating a man she met at church for a month but thinks he's going to "dump" her because of her physical problems. Jane has Type 2 diabetes, which is well-managed with medication. However, she complains of frequent stomach problems, severe headaches, and back pain and says she spends a lot of time researching diseases on the Internet to try to figure out what's wrong with her besides diabetes. Jane has been evaluated by a physician who told her that, other than diabetes, she does not have any medical problems. What DSM-5 diagnosis should the clinician consider first? Select one: a. Somatic Symptom Disorder b. Factitious Disorder c. Illness Anxiety Disorder d. Psychological Factors Affecting Other Medical Condition.

Feedback Answer A is correct: Jane's symptoms are consistent with Somatic Symptom Disorder, which is included in the DSM-5 with Somatic Symptom and Related Disorders. The essential feature of this disorder is the presence of multiple somatic symptoms that cause distress or disruption in one's daily life. Answer B is incorrect: Factitious Disorder is characterized by falsification of physical or psychological symptoms or induction of an illness or injury that is associated with an identified deception. No information given in the question suggests that Jane is faking or causing her symptoms. Answer C is incorrect: Illness Anxiety Disorder is characterized by excessive worry about being or becoming ill and usually does not include somatic symptoms or includes only symptoms of mild intensity. Answer D is incorrect: The diagnosis of Psychological Factors Affecting Other Medical Conditions is assigned when a person's psychological problems affect the course of a medical condition or interfere with its treatment. Jane's symptoms do not seem to be interfering with her management of her diabetes. The correct answer is: Somatic Symptom Disorder

Margaret comes in to see you because her fear of driving on freeway overpasses is beginning to impinge on her life. It takes her 2 hours to get to and from work because she refuses to drive on the freeway. She wants you to help her get over her fear. You specialize in couples and family therapy. You would: Select one: a. Refer her to a therapist who specializes in behavioral treatment. b. Refer her to a physician for anti-anxiety medication. c. Begin couple's therapy to help detriangulate her phobia from the marital dyad. d. Refer her to a physician to rule out possible organic causes.

Feedback Answer A is correct: Phobias are often successfully treated with systematic desensitization that are typically done by a therapist who specializes in behavioral therapy. Anti-anxiety medication might be helpful, but she requested help in getting over her phobia, which the medication alone would not accomplish (B). Couples therapy would be appropriate if the client were requesting help with her relationship with her spouse. There is no mention of Margaret's marital status (C). A phobic reaction is not typically an indicator of an organic problem (D). The correct answer is: Refer her to a therapist who specializes in behavioral treatment.

Eighteen-year-old Rob is brought in to see you by his mother because he keeps getting suspended from school. The problem started when he was 16 and his teacher caught him breaking into another student's locker. Since then he has been suspended twice for theft, and most recently for bullying and starting fights at school. Your DSM-5 diagnosis for Rob would be: Select one: a. Conduct Disorder b. Antisocial Personality Disorder c. V code: Adult Antisocial Behavior d. Oppositional Defiant Disorder

Feedback Answer A is correct: Rob meets the criteria for Conduct Disorder, which includes a pattern of behavior that violates the rights of others or animals. Rob would need to have more pervasive traits of exploitation, aggression, violation of others' rights and lack of remorse for a diagnosis of Antisocial Personality Disorder. Also, he does not have the requisite of at least 3 years of Conduct Disorder symptoms dating from before age 15 (B). The V-code of Adult Antisocial Behavior would apply for isolated incidents of aggression or assaultive behavior. The vignette indicates a pattern (C). A diagnosis of Oppositional Defiant Disorder might apply if Rob had not violated the rights of others (D). The correct answer is: Conduct Disorder

For a diagnosis of Schizophrenia, the DSM-5 requires the presence of two or more active phase symptoms for at least one month with at least one symptom being: Select one: a. hallucinations, delusions, or disorganized speech. b. hallucinations, delusions, or stereotyped motor movements. c. anhedonia, avolition, or other negative symptom. d. depersonalization or derealization.

Feedback Answer A is correct: The diagnosis of Schizophrenia requires the presence of two or more active phase symptoms for at least one month and continuous signs of the disturbance for at least six months. It also requires at least one active phase symptom to be hallucinations, delusions, or disorganized speech. The correct answer is: hallucinations, delusions, or disorganized speech.

Internal Family Systems theory: Select one: a. Views the family as a self-contained system that interacts with society as a unit. b. Melds systemic and psychoanalytic theory by working with the individual's "parts" as an internal system. c. Views the individual's sub-parts as a negative force opposing the integration of a whole self image. d. Is concerned with the dynamics within the family system as internally driven, versus influenced by external factors.

Feedback Answer B is CORRECT: The Internal Family Systems (IFS) model, pioneered by Richard Schwartz, is a synthesis of Systems Theory with the paradigm of Multiplicity of Mind. Therapy utilizes concepts from Structural, Strategic, Narrative and Bowenian schools of family therapy. IFS postulates that an individual's psyche is made up of sub-personalities or "Parts," with an essential 'Self" at the core. Parts react internally in a parallel fashion to that of individuals in a family and of the family system. Everyone has a healthy and healing Self at the core of these sub-personalities, but may have very limited access to it. The Self's role is to modulate the input of the Parts and to lead the internal organizational system. People who are out of touch with this core Self tend to be overwhelmed by their emotions, or ruled by mal-adaptive sub-personalities. The goal of IFS is to help the core Self become the anchoring center of the sub-personalities, in effect, a superego that is able to modulate and harmonize the needs of differing parts of the person.Answer A is incorrect: Internal Family Systems theory focuses on the intrapsychic structure of the individual, not the interpersonal structure of the family or of the family within society.Answer C is incorrect: Unhealthy family dynamics can force Parts into playing roles that are uniquely adapted to the unhealthy family, but are not functional in healthier, more growth producing environments. While there is no such thing as a "bad" Part, Parts can become entrenched in "extremes" of viewpoints, emotions and reactions in an effort to protect the psyche from pain.Answer D is incorrect: See answers "a." and "b." The correct answer is: Melds systemic and psychoanalytic theory by working with the individual's "parts" as an internal system.

John and Virginia Parker, a couple in their 40's, are self-referred and want to work on their marriage. Virginia tells you that they have been married 25 years and that things are just not the same anymore. John tells you that they hardly talk to each other and he misses the good relationship they once had. How would a conjoint family therapist conceptualize their situation? Select one: a. Utilizing Gottman's terms: they are in the Contempt phase of the Four Horsemen. b. They are experiencing a marital schism. c. They are experiencing a marital skew. d. They are in the pursuer-distancer mode.

Feedback Answer B is correct: A marital schism is characterized by estrangement between spouses. Contempt is not where this couple is; as they do not seem hostile (A). A marital skew is characterized by imbalance of power between spouses (C). This couple is not in the pursuer-distancer mode because no one is pursuing; they are both distancing (D). The correct answer is: They are experiencing a marital schism.

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.

Feedback 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.

Cybersex is a form of virtual sex in which two or more persons connect remotely via a computer network and send one another sexually explicit messages, pictures, etc. How does cybersex differ from phone sex? Select one: a. Cybersex is non-commercial, whereas most phone sex is a fee for service arrangement. b. Cybersex differs from phone sex in that it offers a greater degree of anonymity and allows participants to meet partners more easily. c. Cybersex has an addictive quality that phone sex does not. d. Cybersex can satisfy some sexual desires without the risk of sexually transmitted disease or pregnancy.

Feedback Answer B is correct: Cybersex partners may never speak to each other, and do not have to share phone numbers, etc. in order to be in contact, and thus is more anonymous than phone sex. Connecting through the internet is extremely easy and relatively risk free, compared to many other sexual encounters. Answer A is incorrect: While most phone sex arrangements are fee for service, and most cybersex is non-commercial, there are also commercial cybersex providers as well. This answer is too absolute.Answer C is incorrect: Cybersex and phone sex may both be non-addictive, as well as addictive.Answer D is incorrect: While this is a true statement, it does not differentiate between cybersex and phone sex. The correct answer is: Cybersex differs from phone sex in that it offers a greater degree of anonymity and allows participants to meet partners more easily.

Based on the initial evaluation of a 15-year-old boy, a clinician believes the nature and number of his symptoms suggest a DSM-5 diagnosis of Attention-Deficit or Hyperactivity Disorder, predominantly inattentive presentation. Before assigning the diagnosis, the clinician will want to confirm that some symptoms were present before the boy was _____ years of age and that he exhibits them in at least _____ settings. Select one: a. 7; 2 b. 12; 2 c. 6; 3 d. 10; 3

Feedback Answer B is correct: For a diagnosis of ADHD, the DSM-5 requires that "several inattentive or hyperactive-impulsive symptoms were present prior to age 12" (p. 60) and that symptoms are present in at least two settings. Answer A is incorrect: This answer describes the DSM-IV-TR requirements for the diagnosis. The correct answer is: 12; 2

As described in the DSM-5, all Sexual Dysfunctions except Substance or Medication-Induced Sexual Dysfunction require a minimum duration of symptoms of approximately: Select one: a. Three months. b. Six months. c. Nine months. d. 12 months.

Feedback Answer B is correct: The DSM-5 diagnosis of Substance/Medication-Induced Sexual Dysfunction does not have a minimum duration requirement. However, all other Sexual Dysfunctions (e.g., Erectile Disorder, Premature Ejaculation, and Genito-Pelvic Pain/Penetration Disorder) have a minimum duration requirement of approximately six months. The correct answer is: Six months.

In working with a new client, a feminist therapist establishes a collaborative working relationship partly by revealing some of her true feelings and selectively sharing her experiences in order to: Select one: a. Increase empathy for a client's circumstances. b. Maximize the professional distance in the therapeutic relationship. c. Demystify the therapeutic process. d. Define a client's problems and set goals.

Feedback Answer C is correct: A feminist therapist would do these things in order to demystify the therapeutic process and minimize the professional distance and imbalance of power in the therapeutic relationship. A feminist therapist believes in promoting an egalitarian relationship, and one of the ways in which this can be accomplished is through selective self-disclosure. Self-disclosure is not for the purpose of increasing empathy for a client's circumstances (A). A feminist therapist would attempt to minimize, rather than maximize, the professional distance in the therapeutic relationship (B). In feminist therapy, clients assume control of the therapy process by defining their own problems and setting their own goals (D). The correct answer is: Demystify the therapeutic process.

In your first session with Peter and Veronica, they disclose to you that although they have a five-year relationship, Veronica is married to someone else. Ethically, you should: Select one: a. Refuse to see Veronica, but counsel Peter. b. Refuse to provide therapy to either of them until Veronica tells her husband about this affair. c. Provide therapy to the couple. d. Offer to provide therapy to Veronica and her husband.

Feedback Answer C is correct: As therapists, it is important for us not to impose our values and beliefs on our clients. It is acceptable to see two partners together, regardless if one partner is also with someone else. Unless your client is ready for outside support and open to being "public" with her/his problem, the referral might not be helpful. The correct answer is: Provide therapy to the couple.

In the intake session with Vasu, age 29, he discusses the difficulties he is having in dealing with his family. His family is Hindu, but now he is questioning his own spirituality. You, the therapist, are not Hindu. How BEST do you proceed with this client? Select one: a. Refer him to a therapist who specializes in working with spiritual issues. b. Encourage Vasu to bring his family into therapy. c. Explore how Vasu feels about having a non-Hindu therapist. d. Educate yourself about the Hindu religion.

Feedback Answer C is correct: Exploring how Vasu feels about having a non-Hindu therapist would be the best choice as it gives Vasu an opportunity to address this issue. This would be especially important in forming a therapeutic alliance. The vignette doesn't state that the therapist isn't trained to deal with spiritual issues and referrals are not always the best way to proceed. It would be best to determine whether or not Vasu wanted a Hindu therapist (A). Encouraging Vasu to bring his family into therapy may be a good route to take, but initially it would be better to explore how he feels having a non-Hindu therapist. An important issue to consider in family therapy would be how the family would respond to a non-Hindu therapist as well (B). If you are not already educated in the area of the Hindu religion, it would be a good idea to do so. The vignette doesn't indicate whether or not the therapist has any knowledge of the Hindu religion (D). The correct answer is: Explore how Vasu feels about having a non-Hindu therapist.

Monday through Friday, Grace and her son Tommy would have big fights about whether he was going to go to school. After 3 months of therapy, Tommy is finally going to school without fighting, after the therapist suggests they both know what the fights are about, and they don't need them anymore. This change is considered to be a result of: Select one: a. Negative feedback. b. Homeostasis. c. Positive feedback. d. Luck. k.

Feedback Answer C is correct: Positive feedback is anything that creates change in the system. From a systemic perspective, paradoxical directives can be seen as positive feedback. This is pro-change behavior that upsets the family's homeostasis. In this case, Tommy began going to school without a fight. Negative feedback is feedback that keeps the family the same, which has not occurred here (A). Homeostasis is the tendency for a system to return to a previous level of functioning. If Tommy only temporarily went to school without a fight, then this principle would be demonstrated (B). Luck is not a factor in creating therapeutic change (D). The correct answer is: Positive feedbac

Mr. Simms is a withdrawn African American man who was referred by a court diversion program for abusing his wife. He tells you, "I'm only here because I have to be." He was recently laid off from his job and appears hopeless about his future. In connecting with Mr. Simms, all of the following would be inappropriate communication techniques EXCEPT: Select one: a. Expressing interest through direct eye contact. b. Relying heavily on verbal contact. c. Utilizing specific information-gathering questions. d. Relying on reflective listening.

Feedback Answer C is correct: Specific questions would be helpful in dealing with a withdrawn client because they would elicit information about a crisis without being overwhelming or intrusive. Direct eye contact may be perceived as threatening and disrespectful (A). African-Americans rely more heavily on non-verbal communication, so relying more on verbal communication may be inappropriate in this case. (B). Since Mr. Simms is withdrawn, your opportunity for reflective listening would be limited (D). The correct answer is: Utilizing specific information-gathering questions.

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.

Feedback 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.

Sandra and Joyce, a lesbian couple who are raising Joyce's 7-year-old son, Matthew, are complaining of relationship difficulties since Joyce started working in a hospital. Sandra fears Joyce is working late hours because she is having an affair with one of the nurses. The couple is also arguing about Matthew's recent behavior problems both at school and at home. A therapist who is has some reservations in working with a lesbian couple should: Select one: a. Refer the couple to another therapist. b. Discuss his/her feelings with the couple. c. Seek consultation to discuss the issue. d. Continue working with the couple and let the issue resolve itself.

Feedback Answer C is correct: A therapist who has some reservations in working with a lesbian couple should first seek consultation to discuss this issue. If this could not be resolved, it would then be prudent to refer the couple to another therapist. Referring the couple to another therapist would be appropriate if consultation was unsuccessful (A). If a therapist discussed his/her feelings with the client, it would need to be done to promote the therapy, rather than serve as a discharge for the therapist. Subjective countertransference (personal reactions) would not be appropriate to share. Objective countertransference (reactions similar to those the client gets from other people in their world) can sometimes be productively shared with a client. A bias against lesbian couples is subjective countertransference and inappropriate to share (B). Continuing to work with the couple and waiting for the issue to resolve itself is unrealistic (D). The correct answer is: Seek consultation to discuss the issue.

Janet comes to therapy depressed, expressing suicidal ideation. You refer her to a psychiatrist who prescribes an anti-depressant. Almost immediately, Janet becomes socially active and she begins to talk about quitting her job and starting a new career. She tells you that she doesn't need much sleep and spends her nights doing research about her new career on the Internet. How BEST would you proceed? Select one: a. Initiate the termination process since Janet is no longer depressed. b. Reassess Janet's treatment goals now that she is no longer depressed. c. Refer Janet back to her psychiatrist for reevaluation. d. Consider involuntary hospitalization since Janet's condition may present a danger to self and others.

Feedback Answer C is correct: You should refer Janet back to her psychiatrist for reevaluation since her anti-depressant medication seems to have triggered a manic or hypomanic episode. Janet is no longer depressed because she is entering a hypomanic or manic episode. Termination is not warranted at this time (A). While treatment goals would need to be reassessed, it would first be necessary to deal with the possible crisis (B). It would be premature to have Janet hospitalized since there is no evidence that she is a danger to self or others. The best way to deal with this medication-induced crisis is to get her back to the psychiatrist who prescribed the medication, who will assess whether to change or adjust medication (D). The correct answer is: Refer Janet back to her psychiatrist for reevaluation.

Harry and Janet seek therapy because their son, Jason, age 15, is acting out. His mother says that his grades are dropping, he listens to heavy metal music, and he stays out past his curfew. He dresses in torn and dirty clothes. She says he is defiant of household rules and is hostile and sullen most of the time. She tells you that his hair used to be a lovely blond, and now it's purple." He used to be such a sweet boy," she says, "and now my baby won't talk to me anymore." As a structural family therapist, you would see: Select one: a. The parents to strengthen their executive subsystem. b. The entire family to map out the influences from previous generations. c. Jason alone to establish an alliance with him. d. The entire family to evaluate the family's sequence of behaviors.

Feedback Answer D is correct: As a structural family therapist, your preferred initial unit of treatment would be the entire family in order to join and accommodate with the family and evaluate their transactional patterns. As a structural family therapist, your preferred initial unit of treatment would be the entire family in order to evaluate the family's interactional patterns (A). Structural family therapy deals with the here-and-now dynamics occurring in the family. The family map that is created is based on the current relationships, alliances, coalitions, boundaries and the functioning of each subsystem in the present. A family map does not explore past generations (B). Seeing Jason alone to establish an alliance with him is not what a structural family therapist would do. Although it would be important to join with Jason, seeing him alone would reinforce his status as an identified patient (C). The correct answer is: The entire family to evaluate the family's sequence of behaviors.

Mrs. Greenleaf and her two children come in for their first family therapy session. The oldest daughter is 15 and doing average work in school. Her 12-year-old son, Bud, has been moody since the death of his father six months ago. Mrs. Greenleaf complains that she feels helpless in coping with Bud's growing behavior problems. When you begin to discuss the circumstances of the father's death, Bud runs out of the room. Mrs. Greenleaf asks you what to do. How BEST would you respond? Select one: a. Explore with Mrs. Greenleaf her options and let her decide how she wants to handle the situation. b. Send the daughter out, so that you can speak to the mother privately for a few moments. c. Go out and get Bud in order to promote therapeutic rapport. d. Encourage Mrs. Greenleaf to go and get Bud.

Feedback Answer D is correct: Encouraging Mrs. Greenleaf to get Bud supports her in her parenting role. She is the adult who needs to lead the family. The situation needs more of an immediate action and exploring with Mrs. Greenleaf her options may take too much time (A). Sending the daughter would parentify her, and it would be manipulative to use this strategy in order to speak with Mrs. Greenleaf alone (B). If the therapist retrieves Bud, this can give Mrs. Greenleaf the message that she is helpless and cannot manage the family (C). The correct answer is: Encourage Mrs. Greenleaf to go and get Bud.

In an alcoholic family system, an alcoholic continues to drink although family members have frequently asked him to quit. This represents: Select one: a. First order change. b. Second order change. c. Family hierarchy. d. Homeostasis.

Feedback Answer D is correct: Homeostasis is the accustomed way the family functions and this can often be dysfunctional. The alcoholic still drinking would maintain homeostasis. First order change would represent a change in the symptoms in the system. No change has occurred in this case (A). Second order change would represent a change in the overall family system. No change has occurred in this case (B). There is no hierarchy presented here. It is unclear the position of the family member who is the alcoholic (C). The correct answer is: Homeostasis.

During your first session with Mr. and Mrs. Desvelo, Mr. Desvelo says his wife has insisted that he get "some help" with his sleep problems. Mrs. Desvelo states that she's awakened by his frightening screams at least once a week, usually a few hours after they go to sleep, and that this is having a negative effect on her mood and their relationship. Mr. Desvelo has no history of trauma or substance abuse, and he says he recently had a physical and his health is good. In response to your questions, Mrs. Desvelo tells you that her husband sometimes wakes up when he screams and seems agitated but usually goes right back to sleep and doesn't respond to her attempts to calm him; and Mr. Desvelo says that, in the morning, he has no memory of the episode and usually can't recall having had any dreams. Mr. Desvelo's symptoms are most suggestive of which of the following DSM-5 diagnoses? Select one: a. Nightmare Disorder b. Sleep Terror Disorder c. Rapid Eye Movement Sleep Behavior Disorder d. Non-Rapid Eye Movement Sleep Arousal Disorder

Feedback Answer D is correct: A person with Non-Rapid Eye Movement Sleep Arousal Disorder, sleep terror type experiences sleep terror episodes that are usually accompanied by a panicky scream. The person shows signs of autonomic arousal, usually does not fully awaken, is unresponsive to the efforts of others to comfort him/her, rarely remembers any dreams he/she may have had, and has amnesia for the episode on awakening in the morning. Answer A is incorrect: A person with Nightmare Disorder awakens easily and completely and reports having had a vivid dream involving a threat to survival or security. Answer B is incorrect: Sleep Terror Disorder and Sleepwalking Disorder were separate diagnoses in DSM-IV-TR but are included in the DSM-5 as Non-Rapid Eye Movement Sleep Arousal Disorder. Answer C is incorrect: Rapid Eye Movement Sleep Behavior Disorder involves episodes of arousal during REM sleep that are usually associated with vocalizations and/or complex motor behaviors that are consistent with the person's dream. Upon awakening, the person is alert and oriented. The correct answer is: Non-Rapid Eye Movement Sleep Arousal Disorder

Augustine, age 5, is in foster care and enrolled in a therapeutic nursery school. He and his older sister were removed from their home after they were found wandering in the park asking people for food and their parents were both found to have a drug problem. While observing Augustine at school, you notice that he impulsively approaches strangers, tends to be overly familiar with people he has just met, and quickly becomes attached to any adult who pays attention to him. Before assigning a DSM-5 diagnosis of ______________ to Augustine, you will want to confirm that his symptoms are attributable to ______________. Select one: a. Reactive Attachment Disorder, disinhibited type; developmental delays b. Disinhibited Social Engagement Disorder; developmental delays c. Reactive Attachment Disorder, disinhibited type; early neglect or deprivation d. Disinhibited Social Engagement Disorder; early neglect or deprivation

Feedback Answer D is correct: Disinhibited Social Engagement Disorder involves a pattern of culturally inappropriate and overly familiar behavior with unfamiliar people with evidence that the behavior is related to the experience of extremely insufficient care. Answer A is incorrect: The DSM-5 diagnosis of Disinhibited Social Engagement Disorder replaces the DSM-IV-TR diagnosis of Reactive Attachment Disorder, disinhibited type. Note that the presence or absence of developmental delays is not a diagnostic criterion for a diagnosis of Reactive Attachment Disorder or Disinhibited Social Engagement Disorder and, therefore, would not be useful for confirming either diagnosis, which is what this question is asking about. The correct answer is: Disinhibited Social Engagement Disorder; early neglect or deprivation

Eliana, age 32, tells you that she often has trouble concentrating on her work and falling asleep at night because she's constantly worrying about having cancer. She states that her older sister had surgery for breast cancer last year and her mother's sister and uncle both had lung cancer. Eliana says she gets a physical exam every six months and has been reassured by the doctor that she's okay; but she knows that, for some people, there are no symptoms of cancer until it's too late to do anything about it. Eliana also tells you that she keeps checking her breasts for lumps and gets scared whenever she coughs because she thinks it might be an early sign of lung cancer. Eliana's symptoms are most suggestive of which of the following DSM-5 disorders? Select one: a. Body Dysmorphic Disorder b. Somatic Symptom Disorder c. Hypochondriasis d. Illness Anxiety Disorder

Feedback Answer D is correct: Illness Anxiety Disorder is characterized by a preoccupation with having a serious illness, an absence of somatic symptoms or the presence of mild somatic symptoms, a high level of anxiety about one's health, and performance of excessive health-related behaviors (care-seeking type) or maladaptive avoidance of doctors, hospitals, etc. (care-avoidant type). Answer A is incorrect: Body Dysmorphic Disorder is characterized by a preoccupation with a defect or flaw in appearance that appears minor or is unobservable to others. Answer B is incorrect: Somatic Symptom Disorder involves the presence of somatic symptoms, while Illness Anxiety Disorder is characterized by the absence of somatic symptoms or the presence of only minimal symptoms. Eliana is worried about her health but does not actually have physical symptoms. Answer C is incorrect: Hypochondriasis is a DSM-IV-TR diagnosis. The correct answer is: Illness Anxiety Disorder

Following her divorce nine months ago, Melody, age 29, developed intermittent abdominal pain and frequent morning headaches. She's concerned that these symptoms mean that she has cancer or other life-threatening illness, and constant worry about her health has made it difficult for her to care for her children, spend time with her husband, and concentrate at work. Assuming that a physical exam has ruled out a physical cause for her symptoms, the most likely DSM-5 diagnosis for Melody is: Select one: a. Somatoform Disorder NOS b. Conversion Disorder with mixed symptoms c. Pain Disorder d. Somatic Symptom Disorder with predominant pain

Feedback Answer D is correct: The most likely diagnosis for Melody is Somatic Symptom Disorder, which is characterized by the presence of one or more somatic symptoms accompanied by excessive thoughts, feelings, or behaviors related to the symptoms. Because her symptoms involve only pain, the specifier "with predominant pain" is appropriate. Answer A is incorrect: Somatoform Disorder NOS is a DSM-IV-TR diagnosis and is not included in the DSM-5: The DSM-IV-TR category of Somatoform Disorders has been replaced with Somatic Symptom and Related Disorders in DSM-5, and NOS (not otherwise specified) has been replaced with "other specified disorder" and "unspecified disorder." Answer B is incorrect: A diagnosis of Conversion Disorder requires the presence of symptoms that involve a disturbance involuntary motor or sensory functioning and suggest a serious neurological or other medical condition with evidence that the symptoms are incompatible with recognized neurological and medical conditions. Answer C is incorrect: Pain Disorder is a DSM-IV-TR diagnosis and is diagnosed as Somatic Symptom Disorder with predominant pain when using the DSM-5. The correct answer is: Somatic Symptom Disorder with predominant pain

It is most difficult to extinguish behavior that has been: Select one: a. established by a continuous schedule of reinforcement b. established by an intermittent schedule of reinforcement c. established by a combination of verbal rewards and "tokens" d. established through the use of prompts

Feedback Behavior established by an intermittent schedule of reinforcement is the most difficult to extinguish. An example of an intermittent schedule of reinforcement is a slot machine. When using a slot machine, a person is rewarded only occasionally and inconsistently--the person continues to play because he/she doesn't know when the next reward will come (i.e, it might come with the next coin!).Answer B is CORRECT: This is the right answer. See above.Answer A is incorrect: This involves immediate reinforcement. Although, as the question indicated, the use of an intermittent schedule better maintains a behavior, the rate of acquisition (learning) of new behaviors is highest (fastest) when the behavior is reinforced on a continuous schedule; i.e., when reinforcement is provided after each response.Answer C is incorrect: This is not associated with rates of extinction.Answer D is incorrect: This is not associated with rates of extinction. The correct answer is: established by an intermittent schedule of reinforcement

Manuel is a 21-year old college student who moved with his family to the United States from Mexico when he was four years old. Manuel has many Anglo friends at school and usually dates Anglo women, but, at home, he speaks Spanish and participates in the cultural traditions practiced by his family. When asked about his ethnic identity, Manuel says, "I am American and Hispanic, but I guess I consider myself mostly Hispanic." Manuel is best described as: Select one: a. fused b. separated c. assimilated d. bicultural

Feedback Different experts have labeled the different levels or categories of acculturation somewhat differently, but most distinguish between four basic levels - assimilated, integrated (bicultural), separated, and marginal.Answer D is CORRECT: The bicultural individual has adopted both cultures. Biculturalism can be alternating (as in Manuel's case) or blended.Answer A is incorrect: The term "fused" refers to the melting pot position in which the two separate cultures cannot be distinguished.Answer B is incorrect:Separation occurs when the individual is immersed in his/her own ethnic culture and is not part of the larger (dominant) culture.Answer C is incorrect: An assimilated individual has given up his/her own ethnic culture and identifies with the larger (dominant) culture. The correct answer is: bicultural

In general systems theory, what is the implication of equifinality? Select one: a. any change in one part of the system will produce a change in another part of the system b. the more open the family system, the greater the tendency toward disorder c. positive feedback upsets the existing homeostatic balance d. patterns and processes are more important than content in understanding the family's functioning

Feedback Equifinality means, that, no matter where one enters the system, the patterning will be the same. According to this concept, different causes can produce the same results. Therefore, a therapist focuses on patterns and processes when working with a family, rather than individual topics.Answer D is CORRECT: As indicated above, this is an accurate definition of equifinality.Answer A is incorrect: This defines the systems notion of wholeness.Answer B is incorrect: This response makes reference to systems theory but is not a true statement. Although all systems tend toward disorder, the more open a system is, the more able it is to resist this tendency.Answer C is incorrect: This is an accurate statement but it does not define equifinality. The correct answer is: patterns and processes are more important than content in understanding the family's functioning

Betty was referred to you by her primary care physician who could find no medical explanation for her symptoms. Betty says that she's experienced several unexpected "scary episodes" that involved chest pain and feeling unable to breathe and that these episodes make her feel like she's "going crazy." What additional information would help confirm a diagnosis of Panic Disorder? Select one: a. Onset of psychotic symptoms immediately after a panic attack b. Panic attacks triggered by a fear of scrutiny by others c. Persistent worry about having another panic attack d. Mood symptoms when thinking about panic attacks

Feedback Familiarity with the essential features of Panic Disorder would have helped you identify the correct answer to this question.Answer C is correct: Persistent worry about having additional attacks is characteristic of Panic Disorder. Answer A is incorrect: Panic attacks do not involve or trigger psychotic symptoms.Answer B is incorrect: Anxiety related to a fear of scrutiny by others is characteristic of Social Anxiety Disorder.Answer D is incorrect: Worry when thinking about the panic attacks is more characteristic of Panic Disorder than is experiencing mood symptoms. The correct answer is: Persistent worry about having another panic attack

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

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

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

Feedback 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

During your first session with a middle-aged man, he tells that you his wife has suddenly become passive and withdrawn, is sleeping more than usual, and has become disinterested in sex. Your first intervention in this situation should be: Select one: a. to ask the man to bring his wife to the next therapy session b. to call the wife and suggest that she come for individual treatment c. to continue treating the man and attempt to identify and address his role in his wife' s symptoms d. to suggest that the man tell his wife to have a physical examination

Feedback More than one of these interventions may be appropriate at some time but you needed to identify the correct "first" intervention. For many exam questions, the word "first" can be interpreted to mean "most important" or "immediate."Answer D is correct: Ruling out (and, as necessary and appropriate, addressing) physiological factors underlying the woman's symptoms is the important first step.Answer A is incorrect: Although conjoint therapy may be indicated later, the therapist needs to do D first.Answer B is incorrect: Eliminate this, as it would breach the client's confidentiality.Answer C is incorrect: The therapist must investigate the possibility of a medical etiology before he/she can assume that the husband is playing a role in his wife's symptoms. The correct answer is: to suggest that the man tell his wife to have a physical examination

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

Feedback 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

During her first therapy session, a female client complains of headaches, fatigue, and excessive anxiety. The woman says she has a history of anxiety and depression but that her feelings of anxiety are much frequent and intense now. She can think of nothing that precipitated this change in her health and emotional state. The therapist's first priority in this case would be to: Select one: a. Recognize that the headaches, fatigue, and anxiety are symptoms of the client's depression and continue working with her. b. Include in the treatment plan the use of behavioral techniques to alleviate the woman's anxiety. c. Refer the woman to a colleague for psychological assessment if the MFT is not experienced in administering and interpreting assessment techniques him- or herself. d. Refer the woman to a physician because her symptoms might be due to a medical condition.

Feedback Referral for a medical exam is always a first step when physical factors may underlie a client's symptoms.Answer D is correct: This is the best choice. Because the client's symptoms might be due to a medical condition, before developing a treatment plan or determining whether psychological testing is needed, the therapist would want to refer the client to a physician for a medical evaluation.Answer A is incorrect: The therapist cannot conclude this without a medical exam.Answer B is incorrect: This might be useful later, but a medical exam is the first priority.Answer C is incorrect: This might be useful later and you might have been tempted by it since it makes reference to ethical behavior, but referral for a medical exam is the best first step. The correct answer is: Refer the woman to a physician because her symptoms might be due to a medical condition.

If, in therapy, a person from a minority group seems suspicious, mistrustful, and somewhat hesitant to talk to a white-Anglo therapist, the most likely reason is: Select one: a. resistance b. functional paranoia c. transference d. low fluency with English

Feedback Social, economic, and political discrimination are realities for many members of minority and lower SES groups in the United States. Therefore, a person of color who is suspicious of a white-Anglo therapist may be reacting on the basis of his/her past experience.Answer C is CORRECT: As noted, minority group clients may bring feelings derived from their experiences with the majority group into therapy. Thus, when a minority group client is in therapy with a white-Anglo therapist, negative transference may impede therapeutic progress.Answer A is incorrect: The term "resistance" refers to a client's conscious or non-conscious desire to avoid attaining full self-knowledge. Though it is possible that the client is resistant, when working with a client from a different cultural background, therapists should be particularly careful not to misinterpret the client's suspicion or other signs of reluctance as manifestations of resistance.Answer B is incorrect: For the reasons cited above, the therapist should not automatically interpret the client's distrust and reluctance to talk as signs of functional paranoia (which suggests psychopathology).Answer D is incorrect:The mere fact that a person is from a minority group is not sufficient reason to assume that he/she has low fluency with English. The correct answer is: transference

A primary goal of transactional analysis is to help the client become a mature, healthy individual. In terms of the three ego states considered to be central parts of the personality by TA theorists, the healthy adult: Select one: a. relies on all three ego states in an integrated, appropriate way b. relies predominantly on the Adult ego state c. overcomes the influences of his or her constantly battling ego states d. modifies the three ego states to develop a meaningful sense of self

Feedback TA theorists believe that pathology is due to the malfunctioning (e.g., contamination or exclusion) of the three ego states (Adult, Parent and Child).Answer A is CORRECT: This is how TA therapists view the healthy adult. The goals of TA include helping clients integrate their three ego states.Answer B is incorrect: If you didn't know for a fact that "a" was correct, you might have chosen this answer since it includes the word "adult," and the question asks about "the healthy adult." TA therapists, however, view the healthy adult as a person who relies on all three ego states.Answer C is incorrect: This is not what TA therapists believe.Answer D is incorrect: This is not what TA therapists believe. The correct answer is: relies on all three ego states in an integrated, appropriate way

Your client is a 45-year-old woman who says she has not been feeling like her "usual self" lately. She is recently divorced and going back to school to get a Master's degree in marriage and family counseling. Which of the following symptoms would MOST clearly indicate a diagnosis of Major Depressive Disorder for this woman? Select one: a. sleeplessness, difficulty concentrating, and loss of appetite b. loss of interest in normal activities, agitation, and feelings of worthlessness c. loss of appetite, agitation, and feelings of worthlessness d. weight loss, difficulty concentrating and indecisiveness, and hypersomnia

Feedback THE CORRECT ANSWER IS "B"None of the symptoms listed in the answers definitively indicate a major depressive episode which requires the presence five or more characteristic symptoms for at least two weeks. However, the DSM-5 requires that at least one of the five symptoms must be depressed mood or loss of interest in most or all activities. Of the answers given, only answer B includes one of these symptoms and, therefore, is the best answer. The correct answer is: loss of interest in normal activities, agitation, and feelings of worthlessness

Immediately following a rape, the victim is most likely to exhibit: Select one: a. shock and disbelief b. denial c. self-blame d. depression

Feedback The "rape trauma syndrome" involves three phases: Acute reaction, outward adjustment, and integration and resolution.Answer A is CORRECT: The initial response to a rape normally entails shock, disbelief, numbness, disorganization, and severe anxiety.Answer B is incorrect: Denial is more characteristic of the second phase.Answer C is incorrect: Self-blame is more characteristic of the third phase.Answer D is incorrect: Depression in one of the most common psychological consequences of rape but does not usually appear until the third phase. The correct answer is: shock and disbelief

In the first interview, which of the following would be the best way to determine a client's level of motivation? Select one: a. explore her problem b. find out what brought her to therapy c. develop rapport with her d. use methods to reduce her anxiety

Feedback The best measure of a client's level of motivation is who brought him/her to treatment--that is, whether he/she is there voluntarily or involuntarily. Involuntary clients tend to be less motivated.Answer B is CORRECT: This is the best choice; see above.Answer A is incorrect: This is close but less explicit than "b"; the key factor is not so much what the client's problem is but whether he/she is there voluntarily.Answer C is incorrect: This is more related to increasing than assessing motivation.Answer D is incorrect:This is more related to increasing than assessing motivation. The correct answer is: find out what brought her to therapy

How can a therapist use humor with a client? Select one: a. to ease the client's pain b. to establish a relationship with the client c. when a client, without serious pathology, expresses a limited view of something d. a therapist should never use humor with a client

Feedback The correct answer is: when a client, without serious pathology, expresses a limited view of something. when used appropriately and in a timely fashion, humor can be an effective intervention.a. Incorrect The use of humor when a client is in pain would be countertherapeutic and could result in the client experiencing feelings of devaluation and humiliation, which could lead to anger.b. Incorrect It is usually unwise to use humor before a therapeutic relationship is well established.c. CORRECT Using humor in this situation has the potential of advancing a therapeutic issue by offering another perspective.d. Incorrect It is not true that humor should never be used in therapy.

In crisis therapy, which of the following strategies would probably be least useful? Select one: a. providing opportunities for and encouraging catharsis b. identifying the precipitating event c. directly confronting the client's unrealistic beliefs d. giving advice about the circumstances in the client's life

Feedback The crisis therapist uses a variety of strategies to achieve the goals of crisis treatment. Overall, these goals are to relieve the client's symptoms and return the client to his/her previous level of functioning. Your task was to determine what a crisis therapist would be least likely to do.Answer D is CORRECT: Consistent with a client's functional level and current dependency needs, a therapist doing crisis intervention should participate actively and be directive in developing activities that will help the client resolve the crisis. Crisis therapists, however, generally limit their advice to specific treatment issues (e.g., recommending a medication evaluation, suggesting increased contact with the support system) and avoid giving advice about real-life circumstances (e.g., "you should consider divorcing your husband") (see, e.g., Butcher, et al., 1983).Answer A is incorrect: Providing opportunities for discharging the strong emotions that follow a crisis is an important part of crisis therapy, especially during the initial stages.Answer B is incorrect: In contrast to other short-term therapies, the identification of the precipitating event is an important part of crisis therapy.Answer C is incorrect: Although immediately challenging a client's unrealistic beliefs about the crisis situation is not appropriate, in order to resolve the crisis and its aftereffects, it is necessary at some point to confront the client about his/her maladaptive beliefs and behaviors. The correct answer is: giving advice about the circumstances in the client's life

During their first therapy session, Mr. and Mrs. Stewart say that their 8-year-old son has a learning problem. They state that they have tried to tutor him at home, but "nothing seems to help." The father says that he is "very frustrated" and doesn't know what else he can do to help his son. Mr. Stewart is an accomplished musician and is used to success, and Mrs. Stewart is an executive at a large corporation. What would you do FIRST in this situation? Select one: a. Refer the child to a tutor who specializes in working with children with learning disorders. b. Refer the parents to a parenting skills group. c. Consult with the child's doctor. d. Consult with the child's teacher.

Feedback The first thing you would want to do would be to ask the parents why they think that their child has a learning problem and determine what they mean by a "learning problem." This isn't given as a choice, so you have to choose next best action.Answer D is correct: The child's teacher would be the best source of information about the boy's problems since he or she is familiar with any learning-related difficulties he may have.Answer is incorrect: You would not make a treatment referral before diagnosing the boy's problem.Answer B is incorrect: There is no indication that the parents need to be referred to a parenting skills group. In addition, this referral would not help you assess and diagnose the boy's problems.Answer C is incorrect: The doctor could help to rule any medical conditions that might be contributing to the boy's problems. However, given the nature of the parents' concerns, your first consultation should be with the child's teacher. The correct answer is: Consult with the child's teacher.

Clementine, an 18-year-old high school senior, is referred for therapy by her physician. She went to see her doctor due to constipation and menstrual irregularity. Though slightly underweight, Clementine talks excessively about being fat and unattractive. When prompted by the MFT, she admits to thinking that food is a "tyrant" in her life. She also discloses that she sometimes "gorges on food" to a point where she feels sick and throws up, but is quick to add that she does this no more than a couple of times a week. Based on this information, the most likely diagnosis for Clementine is: Select one: a. Anorexia Nervosa, binge eating or purging type. b. Bulimia Nervosa. c. Major Depressive Disorder with atypical features. d. Body Dysmorphic Disorder.

Feedback The information presented in this question suggests that Clementine has an eating disorder.Answer A is incorrect: Anorexia and Bulimia share some features (e.g., disturbed body image), but a person with Anorexia refuses to maintain weight over a minimal normal level for her height and age.Answer B is correct: The primary clue indicating that Clementine has Bulimia, rather than Anorexia, is that she is only slightly underweight. Other signs of Bulimia include her lack of control over eating ("food is a tyrant"); her preoccupation with her body shape and weight; and her gorging on food and vomiting. Finally, menstrual irregularity (and even amenorrhea) occurs in some females with Bulimia and constipation can develop in individuals who chronically abuse laxatives.Answer C is incorrect: Major Depressive Disorder with atypical features often includes overeating, but Clementine is not exhibiting other symptoms of depression.Answer D is incorrect: You can rule this out since Clementine clearly seems to have an eating disorder. The essential feature of Body Dysmorphic Disorder is a preoccupation with an imagined or minor physical flaw. The correct answer is: Bulimia Nervosa.

During the first session with the victim of spousal abuse, a feminist therapist would most likely: Select one: a. Help the woman recognize the social and political forces that are keeping her in the abusive relationship b. Help the woman identify the ways in which she provokes her husband's anger c. Insist that the woman go to a shelter for battered women or other safe place d. Help the woman identify and rehearse an "escape plan" to use when her husband becomes abusive

Feedback The key phrase in this question is "during the first session."Answer D is correct: According to Walker, one of the leading advocates of feminist therapy, a primary goal during the crisis intervention (first) phase of therapy is to help the abused woman rehearse an escape plan ("Feminist Therapy with Victims/Survivors of Interpersonal Violence"; in L. B. Rosewater and L. E. A. Walker (Eds.), Handbook of Feminist Therapy, 1985).Answer A is incorrect: Although helping female clients recognize the impact of oppressive social and political forces on their attitudes and behaviors is an important part of feminist therapy, it would probably not be the first step in therapy when the presenting problem is spousal abuse.Answer B is incorrect: Feminist therapists (and most, if not all, other therapists) would not emphasize the woman's responsibility for the abuse, at least not in terms of her "provocation" of the abuse.Answer C is incorrect: A feminist therapist would not be likely to "insist" that a woman go to a shelter, although this would probably be discussed as an option. The correct answer is: Help the woman identify and rehearse an "escape plan" to use when her husband becomes abusive

What would an object relations therapist address as termination approaches? Select one: a. how goals of therapy were met b. separation and abandonment issues c. how to deepen communication skills within the family d. the level of psychological defensiveness

Feedback The object relations theorists regard maladaptive behavior as the result of abnormalities in object relations (the emotional bonds between self and others). They emphasize the effects on personality development of a young child's relationship with "objects" (significant others)--the child internalizes his/her early interpersonal relationships with caregivers, and these become the model for subsequent interpersonal relationships in the family-of-origin, mate selection, and all other close or intimate relationships.Answer B is CORRECT: An object relations therapist would anticipate a client having a re-emergence of issues of abandonment and separation at the time of termination.Answer A is incorrect: This would be a consideration for any therapist. Answer "b" is a more specific consideration for an object relations therapist.Answer C is incorrect: This would be addressed as part of the therapy process, not at termination.Answer D is incorrect: "b." is a better choice. The correct answer is: separation and abandonment issues

Father-daughter incest may produce either sexual promiscuity or sexual inhibition in the daughter during adulthood. This illustrates which of the following? Select one: a. equifinality b. wholeness c. equipotentiality d. non-summativity

Feedback The question illustrated a clear example of equipotentiality, which is a general systems theory concept proposing that one cause (e.g., incest) may produce different results (e.g., promiscuity or sexual inhibition).Answer C is CORRECT: This is correct; see above.Answer A is incorrect: The general systems theory concept of "equifinality" proposes that no matter where one enters a system, the patterning will be the same. According to this concept, different causes can produce the same results and, thus, a therapist should study patterns of behavior and interaction in a client family rather than individual topics.Answer B is incorrect: The general systems theory concept of "wholeness" proposes that every part of a system is so related to its fellow parts that a change in one part of the system inevitably causes a change in the other parts and in the whole system.Answer D is incorrect: Non-summativity means "the whole is equal to more than the sum of its parts"; thus, the family has a history and function of its own beyond the identities of its members and is a treatable entity, not just a collection of individuals. The correct answer is: equipotentiality

A woman complains that, no matter where she goes, she smells rotting fruits and vegetables. This is an example of a(n): Select one: a. Illusion b. Hallucination c. Delusion d. Fugue

Feedback The terms in the answers might have been confusing--you should learn to distinguish among them for the exam.Answer A is incorrect: An illusion is an erroneous perception; i.e., a false response to an existing sense stimulus.Answer B is correct: The woman smells rotting fruits and vegetables everywhere she goes, and we can assume that there are not rotting fruits and vegetables in all these places. A hallucination is a sensory perception in the absence of an external stimulus, and may occur in any of the five senses. When an hallucination involves smelling something that is not there, it is known as an olfactory hallucination.Answer C is incorrect: A delusion is a false idea or belief (not a sensory perception) that is held despite obvious evidence to the contrary.Answer D is incorrect: A fugue state is characterized by a sudden and unexpected leaving of home along with the assumption of a new identity elsewhere. During the fugue, the person does not recall his/her previous identity. The correct answer is: Hallucination

In their book, A Theory of Multicultural Counseling and Therapy, Sue, Ivey, and Pedersen (1996) describe three multicultural counseling competencies. These are: Select one: a. ability, knowledge, sensitivity b. flexibility, sensitivity, awareness c. awareness, knowledge, skills d. awareness, sensitivity, technique

Feedback The three multicultural counseling competencies described by Sue, Ivey, and Pedersen (1996) were originally identified by D. W. Sue et al. (Position paper: Cross-cultural counseling competencies, The Counseling Psychologist, 1982, 10, 45-52).Answer C is CORRECT: The first competency is awareness of one's own values, beliefs, and stereotypes regarding human behavior. The second competency is knowledge about the worldview of minority and culturally-different clients. Finally, the third competency is possession of culturally-appropriate counseling skills. 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: awareness, knowledge, skills

Bipolar II Disorder is distinguished from Bipolar I Disorder by the requirement for Bipolar II Disorder for the presence of which of the following? Select one: a. Manic and major depressive episodes b. At least one psychotic episode c. Hypomanic and major depressive episodes d. Two or more major depressive episodes

Feedback This is a straightforward question that requires you to be familiar with the diagnostic criteria for the Bipolar Disorders.Answer C is correct: The presence of hypomanic and depressive episodes is required for the diagnosis of Bipolar II Disorder but not Bipolar I Disorder. Answer A is incorrect: The presence of at least one manic episode is required for Bipolar I Disorder but not Bipolar II Disorder.Answer B is incorrect: The presence of a psychotic episode is not required for Bipolar I or Bipolar II Disorder.Answer D is incorrect: The diagnosis of Bipolar II Disorder requires the presence of at least one major depressive episode (not two or more), and Bipolar I Disorder may or may not include one or more major depressive episodes. The correct answer is: Hypomanic and major depressive episodes

A therapist who wants to assess the intelligence of a 3-year-old child could use which of the following tests? Select one: a. WAIS-IV b. WISC-V c. SB-5 or WISC-V d. SB-5 or WPPSI-IV

Feedback This is a straightforward recall question that requires basic knowledge of commonly used intelligence test.Answer D is correct: The WPPSI-IV is appropriate for children ages 2 years, 6 months through 7 years, 7 months.Answer A is incorrect: The WAIS-IV is used with individuals aged 16 through 90.Answer B is incorrect: The WISC-V is used with individuals aged 6 years through 16 years, 11 months.Answer C is incorrect: The SB-5 (Stanford-Binet, Fifth Edition) is appropriate for individuals ages 2 through 85+, but the WISC-V is appropriate for individuals ages 6 years through 16 years, 11 months. The correct answer is: SB-5 or WPPSI-IV

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

Feedback 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

Feedback 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

An MFT is doing grief work with an individual whose wife has just died. The client is in crisis. In the initial session with this client, the MFT is least likely to do which of the following? Select one: a. allow the client to express his feelings, including sorrow, guilt, anger, etc. b. encourage the client to resume normal relationships with his loved ones c. normalize the intense feelings associated with the loss d. help the client accept his pain and loss

Feedback This question asks about the initial session with a grieving client and for what the therapist is least likely to do. The goals of normal grief work include open expression of pain, sorrow, guilt, and hostility; acceptance of the pain and loss; understanding of the intense feelings associated with the loss; and eventual resumption of normal activities and social relationships in the absence of the person who has died (Hoff, 1984).Answer B is CORRECT: An individual usually needs to work through the memories and feelings associated with the loss before he/she is able to develop new patterns of social interaction in the absence of the person who has died.Answer A is incorrect: This would be appropriate in the initial session.Answer C is incorrect:This would be appropriate in the initial session.Answer D is incorrect:This would be appropriate in the initial session. The correct answer is: encourage the client to resume normal relationships with his loved ones

Behavior that is overly dramatic, reactive, intensely expressed, and perceived by others as shallow and superficial is characteristic of which of the following Personality Disorders? Select one: a. Borderline b. Schizotypal c. Obsessive-Compulsive d. Histrionic

Feedback This question describes key symptoms of Histrionic Personality Disorder.Answer D is correct: Behavior that is overly dramatic and reactive, intensely expressed, and perceived by others as shallow and superficial characterizes Histrionic Personality Disorder. Other features of this disorder include excessive emotionality and attention-seeking and various disturbances in social relations, such as a lack of consideration for others and excessive demands for reassurance.Answer A is incorrect: According to the DSM, Borderline Personality Disorder involves a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.Answer B is incorrect: According to the DSM, Schizotypal Personality Disorder involves a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships, cognitive or perceptual distortions, and eccentricities of behavior.Answer C is incorrect: According to the DSM, Obsessive-Compulsive Personality Disorder involves a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. The correct answer is: Histrionic

In an initial session with a family, you notice the anxiety level in the room rising. You should: Select one: a. teach stress reduction techniques b. go on trying to define the presenting problem c. have each family member focus on the source of his or her own anxiety and then resume your attention to the group as a whole d. reframe the anxiety as anticipation

Feedback This question is specifically about what intervention would be best when initially seeing a family and noticing the anxiety level escalating.Answer C is CORRECT: This intervention is aimed at raising each family member's awareness of the source of his/her own anxiety, as well as then focusing on the family as a whole. As far as family systems, circular causality and nonsummativity are two of the terms that come to mind in this situation.Answer A is incorrect: You may indeed wish to do this at a later date but should consider the possibility of another, more immediate, intervention first.Answer B is incorrect: It is important to define the presenting problem but, if you are noticing a high anxiety level in the session, it is important to have each family member notice the anxiety as well.Answer D is incorrect: It may be tempting to reframe this family's anxiety as anticipatory anxiety considering that this is an initial session. However, such an interpretation might be wrong and, therefore, detrimental. (For example, anticipatory anxiety usually subsides once the individuals are in the anticipated situation but the information contained in this question indicates that the anxiety level is continuing to rise.) The correct answer is: have each family member focus on the source of his or her own anxiety and then resume your attention to the group as a whole

The "duty to warn" primarily refers to: Select one: a. warning an intended victim of threatened harm b. warning an intended victim of threatened harm to his or her property c. contacting the appropriate authorities when a client is clearly homicidal d. informing the family that a client is suicidal

Feedback This question required you to know about a therapist's obligation to breach confidence, as per state laws derived from the Tarasoff ruling or "duty to warn."Answer A is CORRECT: According to the Tarasoff ruling, when a client threatens to harm an identifiable victim, the therapist who hears this threat is obligated to attempt to warn the intended victim and to contact the police. The psychologist involved in the original Tarasoff decision did notify the police of the threat to Tatiana Tarasoff; however, this was not sufficient to protect Tatiana, and the Tarasoff ruling, thus, extended a psychotherapist's obligations so that they now also include warning the identifiable, intended victim.Answer B is incorrect: Threats to property are not covered by the "duty to warn," only physical violence.Answer C is incorrect: When a client is homicidal, it may be necessary (and is legally and ethically permissible) to contact the appropriate authorities. However, this responsibility is not covered under the "duty to warn" unless there is an identifiable victim, which is missing in this answer.Answer D is incorrect: A therapist may notify a family that a family member is suicidal if this is necessary to prevent the harm. This, however, is not a circumstance covered by the "duty to warn." The correct answer is: warning an intended victim of threatened harm

From a systems point of view, the identified patient's symptoms serve as: Select one: a. a balancing mechanism and positive feedback b. a balancing mechanism and negative feedback c. positive and negative feedback mechanisms d. a balancing mechanism and positive and negative feedback

Feedback This question required you to understand the processes listed in the answers. The identified patient is the "symptom bearer" in the family, or the official patient identified by the family. He/she "absorbs" and alleviates the pain of other family members.Answer B is CORRECT: This is the right answer: the I.P.'s symptoms serve to maintain a family's homeostasis or balance. Negative feedback is used to recalibrate the system when it is in trouble and restores the previous state of balance; i.e., it maintains homeostasis or the status quo in a family. For example, the literature often cites instances when the recovery of the I.P. is sabotaged by other family members or leads another member to become symptomatic. This happens because the family needs someone to be symptomatic so that it can return to its familiar way of functioning or "regain its balance." Answer A is incorrect: It is true that, through negative feedback, the identified patient's symptoms maintain the family's balance, or homeostasis. Positive feedback, however, is wrong since positive feedback changes the system.Answer C is incorrect: This can't be correct, since it includes positive feedback.Answer D is incorrect: This can't be correct, since it includes positive feedback. The correct answer is: a balancing mechanism and negative feedback

The therapist is using RET to treat a client's depression. During the first session, the therapist identified the client's perception of his life included "irrational thought beliefs." It is now coming to the end of therapy. How would the therapist know that therapy is complete: Select one: a. when the client's unconscious material surfaces b. when the therapeutic goals have been met c. when the client learns to separate thoughts from feelings d. when the client says that therapy is complete

Feedback This question requires you to make your best guess, based upon what you know about RET. Also, a process of elimination might have been useful. Remember that RET is a cognitive therapy approach.Answer B is CORRECT: RET is a behavioral approach intended to change irrational thought beliefs or faulty cognitions. As such, it follows a treatment plan aimed at meeting these specific goals.Answer A is incorrect: This answer reflects a psychodynamic approach. Cognitive therapies address current thoughts, not unconscious material.Answer C is incorrect: This answer describes the process of differentiation, which is the primary goal of Bowen.Answer D is incorrect: RET is more directive than this answer suggests. The therapist and client would determine together when therapy is complete. The correct answer is: when the therapeutic goals have been met

During your first session, a new client tells you that she sometimes gets very light-headed and "shaky" and that, during these periods, she has an impending sense of doom and feels like she's going to die. She says these feelings "come and go" and don't seem to be related to anything she's doing at the time. A representative from her insurance company calls a few days after this session and requests a diagnosis. He says the company will not reimburse for the session unless it receives a diagnosis with the first billing. You generally do not like to assign a diagnosis without doing a complete assessment, but you want to get paid. Therefore, you hazard an "educated guess" and assign which of the following diagnoses? Select one: a. Panic Disorder b. Generalized Anxiety Disorder c. Schizoid Personality Disorder d. Schizophreniform Disorder

Feedback This vignette does not offer much in terms of symptoms, so you have to do the best you can to arrive at a tentative diagnosis. Many questions on the MFT exam will not list the full criteria for a diagnosis but will, instead, only hint at the probable diagnosis.Answer A is correct: Panic Disorder requires the occurrence of at least two unexpected panic attacks that include physical symptoms (e.g., light headednes) and cognitive symptoms (fear of dying).Answer B is incorrect: Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and worry about multiple events. It is not associated with an impending sense of doom or fear of dying.Answer C is incorrect: Schizoid Personality Disorder does not involve the symptoms described in the question.Answer D is incorrect: Schizophreniform Disorder does not fit the clinical picture described here. The correct answer is: Panic Disorder

When a client says that she is terminating therapy, a therapist should: Select one: a. make a proper referral b. suggest she come in a few more times before making any definite decisions c. try to change her mind if he or she thinks the client is not ready to terminate d. insist that the client remain in treatment if she is not ready to terminate since marital and family therapists must always serve their clients' best interests

Feedback Though the item didn't indicate this directly, the correct answer can be found in AAMFT's Ethical Principles. The stem asked what for the therapist "should do," which implies that the examiners are looking for some sort of "ethical" response.Answer A is CORRECT: Among the answers, making a proper referral is the only thing you would definitely need to do. AAMFT Principle 1.9 states, "marriage and family therapists continue therapeutic relationships only so long as it is reasonably clear that clients are benefiting from the relationship." Principle 1.11 states, "marriage and family therapists do not abandon or neglect clients in treatment without making reasonable arrangements for the continuation of such treatment."Answer B is incorrect: See explanation for answer "a."Answer C is incorrect: See explanation for answer "a."Answer D is incorrect: Yes, it is true that marital and family therapists should strive to meet their client's best interests; however, "insisting" that this client stay in treatment with you, against her wishes, would obviously not be in her best interests. The correct answer is: make a proper referral

a. "What does it feel like to be anxious?" b. "Who in your family makes you feel most anxious?" c. "What benefits do you achieve by being anxious?" d. "What are you doing to make yourself anxious?"

Feedback You had to recall the focus of reality therapy and apply it to the question. According to Glasser (the founder of reality therapy), most forms of mental and emotional disturbance are the result of a decision not to fulfill one's needs in a responsible way, which then produces a failure identity. For example, from the perspective of reality therapy, individuals are not depressed but, instead, are "depressing" themselves through the conscious decisions they make about how to fulfill their needs. Therefore, reality therapists encourage clients to take responsibility for themselves and to focus on their present behaviors.Answer D is CORRECT: This is the right answer, as it asks the client to identify what he/she is doing to make him/herself feel anxious. In other words, it asks the client to identify how he/she is responsible for his/her anxiety.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: "What are you doing to make yourself anxious?"

Attention-Deficit or Hyperactivity Disorder (ADHD) is usually characterized by all of the following except: Select one: a. High levels of activity b. Distractibility during play c. Lower than average IQ d. Excessive talking

Feedback You needed to identify the feature that is not characteristic of hyperactivity. ADHD is characterized by developmentally inappropriate degrees of inattention and/or hyperactivity-impulsivity.Answer C is correct: Although the inattention and other symptoms associated with ADHD may lead to academic underachievement and many children with ADHD have other learning problems, a lower than average IQ is not associated with ADHD.Answer A is incorrect: This is clearly associated with ADHD.Answer B is incorrect: This is common; individuals with ADHD may have difficulty sustaining attention in either tasks or play activities, or both.Answer D is incorrect: Excessive talking his can be one of the signs of hyperactivity associated with ADHD. The correct answer is: Lower than average IQ

Bill, a 32-year-old fireman, was referred to therapy by his EAP. Several months ago, he lost one of his co-workers in a fire. Bill can't shake the feeling that he is responsible for his co-worker's death. He states, "I should have tried harder to save him." Bill has become withdrawn in his marriage and other relationships. He is having difficulty functioning at work. As a cognitive-behavioral therapist, you MOST likely think Bill's problems are a result of: Select one: a.A distortion of reality based on incorrect premises and assumptions. b.Chronic anxiety leading to a high level of emotional reactivity. c.An exaggerated feeling of inferiority and an insufficiently developed feeling of community. d.An inability to experience contradictory feelings leading to a distortion of perception.

Feedback Your an swer its correc.Answer A is correct: According to cognitive-behavioral therapy, Bill's psychological problems are a result of a distortion of reality based on incorrect premises and assumptions, i.e., Bill's belief that he is somehow responsible. Chronic anxiety leading to a high level of emotional reactivity is a Bowenian concept (B). An exaggerated feeling of inferiority and an insufficiently developed feeling of community is an Adlerian concept (C). An inability to experience contradictory feelings leading to a distortion of perception describes the object-relations concept of splitting (D). The correct answer is:A distortion of reality based on incorrect premises and assumptions.

Mrs. Robinson comes to see you complaining of headaches. She also explains she is tired of married life and her children. She reports having been evaluated by her general doctor and a neurologist, neither of whom can find a medical cause. An MRI theorist might conceptualize her headaches as: Select one: a. A covert message. b. Communication. c. A paradox. d. A marital skew.

Feedback. Answer A is correct: According to an MRI theorist, symptoms such as Mrs. Robinson's headache, can serve as a covert message. They can also be a comment on relationships and a command to be responded to by the other party. The correct answer is: A covert message.

A therapist is seeing a rape victim at a crisis center. The first intervention should be: Select one: a. send the client to a support group since the strong emotions can best be contained in a group setting. b. mobilize her support system with a referral to a support group when her emotions have abated. c. encourage her to relate the details of her experience. d. help her make a self-care plan for the next 24 to 48 hours.

In crises, the goal is to help the client return to their previous level of functioning. Two of the answer choices focus on this goal.Answer D is CORRECT: This intervention would likely include mobilizing her support group along with other empowering suggestions to help begin the recovery process. The goal is to move from oppression to empowerment.Answer A is incorrect: Referring the client to a support group for the reason given in this answer choice is incorrect.Answer B is incorrect:This answer choice includes a good intervention but the referral to a support group is not done when the emotions have abated.Answer C is incorrect: This is a good early intervention but a self-care plan needs to be in place first, or the client could leave the session feeling more overwhelmed without a sense of how to take care of herself. The correct answer is: help her make a self-care plan for the next 24 to 48 hours.

A therapist tells a client who wants to quit smoking that he should keep his only pack of cigarettes in a place that is accessible only by walking for more than one mile. This is an example of which of the following paradoxical techniques? Select one: a. reframing b. symptom prescription c. ordeal d. restraining

In this situation, smoking becomes self-punishing because of the amount of work (walking one mile) it will take in order to smoke.Answer C is CORRECT: Haley (1984) described several types of ordeals. One type involves having the individual perform an unpleasant or inconvenient act in order to engage in the target behavior - which is what this question describesAnswer A is incorrect: Reframing involves helping the client see a behavior in a different (and usually more positive) way.Answer B is incorrect: Symptom prescription (aka prescribing the symptom) involves instructing the client to engage in the undesirable behavior in order to help the client recognize that the behavior is under his/her control.Answer D is incorrect: Restraining involves encouraging the client not to change in order to elicit resistance and thereby facilitate change. The correct answer is: ordeal

A structural therapist sees a mother, father, and their adolescent child for family therapy. The child has been displaying serious conduct problems. How might the therapist conceptualize the problem? Select one: a. through the use of "I" statements b. bringing unconscious mental contents into consciousness c. differentiation d. boundaries

Structural family therapy is associated with the work of Minuchin and describes the family as having an underlying organization. The organization of subsystems and boundaries in the family are thought to define interactional patterns and behavior.Answer D is CORRECT: Of the choices listed, a structural therapist would be most likely to focus on boundaries, which are the rules that determine the amount of contact allowed between family members.Answer A is incorrect: The use of "I"-statements is most closely associated with gestalt therapy, not structural therapy.Answer B is incorrect: The bringing of unconscious mental contents into consciousness is characteristic of psychoanalysis, not structural therapy.Answer C is incorrect: Differentiation is a primary goal of Bowen's extended family systems therapy, not structural therapy. The correct answer is: boundaries

A structural family therapist's interventions with a triangulated family would be designed to: Select one: a. foster insight in order to establish more appropriate hierarchies and boundaries b. create stress in order to unbalance the family's homeostasis c. dilute the tension between family members in order to reduce triangulation d. alter the family's implicit and explicit rules in order to modify dysfunctional interactional patterns

Structural family therapy is concerned with restructuring the family.Answer B is CORRECT: Before the family's structure can be altered, its homoeostatic state must be unbalanced so that family members are more susceptible to change. This is accomplished by interjecting some type of stress into the family.Answer A is incorrect: Structural family therapy is based on the premise that action precedes understanding and it is geared more toward changing behaviors and transactions than fostering insight.Answer C is incorrect: As noted in the rationale for "b," this is essentially the opposite of the correct answer.Answer D is incorrect: This goal described in this response is associated is communications family therapy. The correct answer is: create stress in order to unbalance the family's homeostasis

A therapist works with a family in which he hypothesizes that a scapegoated child's behavior may be his or her means of loyally acting out his or her parents' need for expressing rage and that this is a cycle that may have connections to behavioral sequences begun generations before. This therapist is most likely assessing from: Select one: a. a Bowenian model b. a Ericksonian model c. a structural model d. a contextual model

The key words in this question were "loyally acting out" and "begun generations before." There are two models mentioned in the answer choices that consider family history important. There is only one that considers loyalty important, however. Did you choose the right one?Answer D is CORRECT: Ivan Boszormenyi-Nagy's contextual approach is associated with the ethical concepts of loyalty, trust, emotional indebtedness, entitlement, and fairness in relationships between family members.Answer A is incorrect: Bowen does consider family history important but loyalty is not one of his concepts.Answer B is incorrect: Milton Erickson is associated with strategic therapy.Answer c is incorrect: Minuchin's work is not associated with the importance of either family history or loyalty. The correct answer is: a contextual model

A new client presents with rambling, rapid speech, impaired attention, and excessive activity and says he's also experienced prominent depressive symptoms. A probable diagnosis is: Select one: a. Schizoid Personality Disorder b. Borderline Personality Disorder c. Bipolar I Disorder d. Brief Psychotic Disorder

The symptomology presented in this question is vague enough to indicate any number of disorders, but specific enough for you to pick the "best" answer.Answer C is correct: The essential feature of Bipolar I Disorder is one or more manic episodes which may have been preceded or followed by hypomanic or depressive episodes. Answer A is incorrect: Schizoid Personality Disorder is characterized by an indifference to social relationships, flat affect, and limited emotional expression.Answer B is incorrect: Borderline Personality Disorder shares some symptoms with Bipolar I Disorder, but the client is not exhibiting the characteristic feature of this personality disorder -- i.e., a pervasive pattern of instability of interpersonal relationships, self-image, and affects and marked impulsivity.Answer D is incorrect: The client is not exhibiting any symptoms of psychosis, which rules out a diagnosis of Brief Psychotic Disorder. The correct answer is: Bipolar I Disorder

Bob has had HIV disease for several years. He has been in a relationship for two years, but is seen alone by the therapist. This is the first time Bob has sought help from a therapist. A few days ago, he was told by his physician that his HIV disease has progressed to AIDS. Bob has never told his girlfriend about his HIV diagnosis. He is concerned about ever having to tell her that he is sick. What should the therapist do: Select one: a. get Bob support, such as community groups and resources b. notify Bob's girlfriend c. do grief work and have Bob tell his life story d. explore Bob's denial

This is a difficult question. To arrive at the "best" answer, you should have considered that, without doing "d" first, the therapist might not be able to accomplish the interventions mentioned in "a" and "c."Answer D is CORRECT: This would seem to be the "best" choice. Apparently, Bob has had HIV disease for several years without telling his girlfriend about his condition. This sounds like there may be a strong denial mechanism at work, which should be a primary focus of therapy initially. Moreover, as noted in the rationale for "b," a related goal would be to convince Bob to inform his girlfriend about his HIV serostatus. In fact, several court cases in California have established that individuals have a duty to inform their sexual partners when they are infected with a sexually transmitted disease before engaging in activities that could transmit the disease. This standard can apply to HIV infection, since HIV disease can be sexually transmitted. Therefore, in tandem with addressing his denial, you should also educate Bob about his duty to tell his girlfriend that he is HIV-positive and encourage him to engage in only safe behavior. You should then monitor Bob's progress in fulfilling these obligations. If Bob continued to be reluctant to inform his girlfriend, you would need to help him make the disclosure (perhaps you could present when the disclosure is made).Answer A is incorrect: See the above explanation. This is something the therapist would want to do with Bob, after doing "d."Answer B is incorrect: At this point, you cannot ethically or legally breach confidentiality to tell Bob's girlfriend about his diagnosis. Even though a communicable disease is considered a legitimate reason to break confidentiality to prevent the spread of the disease, the relationship between HIV risk and Tarasoff-type warnings is ambiguous for a number of reasons. For one thing, the duty to warn is invoked only when a client makes a direct verbal threat in the presence of a therapist. Like Bob, however, most HIV-positive clients, do not use their infection to harm other people intentionally. Instead, when there is a "threat" resulting from a client's HIV infection, it is more likely to arise from his failure to use proper precautions. In addition, most people (including we can assume, Bob's girlfriend) already know about the behaviors associated with a high risk of contracting HIV, and have been advised to protect themselves from these risks. Therefore, a client's victims -- those who may be exposed to the client's virus through sexual or needle-sharing contact with him -- are probably already aware of the risks associated with their own behavior. According to Wood, Marks, and Dilley (1992) for the "duty to warn" to arise with an HIV+ client, all the following conditions have to be met: (1) the client is HIV-positive; (2) on a regular basis, the client and another person engage in unsafe behavior associated with HIV transmission; (3) this behavior is actually unsafe; (4) the client plans to continue engaging in this behavior even after you have counseled him to stop; and (5) HIV transmission is likely to occur in the future (in other words, Bob's past sexual contacts with his girlfriend do not invoke the duty to warn). If any one of these conditions is absent, there is no imminent danger and, therefore, no duty to warn. On the other hand, notice how this discussion suggests that you have an obligation to encourage Bob to tell his girlfriend about his serostatus. See also the rationale for "d."Answer C is incorrect: Doing grief work would be an excellent intervention. Having a client with a possible terminal illness tell his life story is a good way of helping him work through unfinished business. The therapist would want to attempt "d" before this, since "d" represents a major piece of unfinished business that is happening in the present. The correct answer is: explore Bob's denial

A teacher contacts a school counselor to discuss signs of child abuse. She is concerned about one of her students who has been acting strangely. The counselor would tell the teacher that which of the following characteristics in the child is MOST likely to indicate child abuse: Select one: a. Aggressiveness b. Inattentiveness c. Regression d. Compassion

This question is difficult because three of the responses -- "a," "b," and "c" -- list problematic behaviors that could result from child abuse.Answer C is correct: Whereas aggression and inattentiveness could be due to many causes other than child abuse (e.g., school problems or disruptive behavior disorders), regression implies an interruption of normal functioning, typically indicating some type of trauma, such as child abuse. Answer A is incorrect: Although aggressiveness can be a sign of child abuse, it can also be associated with a variety of other causes, such as Conduct Disorder or even frustration.Answer B is incorrect: Inattentiveness can result from a variety of circumstances or disorders, other than child abuse, such as a learning disability, ADHD, or even boredom.Answer D is incorrect: Compassion is a desirable altruistic behavior and is more likely to indicate that appropriate, positive experiences are occurring in the home. The correct answer is: Regression

The therapist has been seeing a client for ten sessions when the client calls and leaves a message saying that she is not coming back to therapy because she is "all better." What has happened? Select one: a. The client has gotten better b. The client has gotten worse c. Transference has taken over d. Repression has lessened

This question is referencing what has been called a "flight into health." Sometimes clients will abruptly leave therapy when the work begins to deepen because painful and scary feelings or memories begin emerging. This will often take the conscious form of "feeling better" as a defense against the lifting repression.Answer D is CORRECT: The client most likely is beginning the process of "working through," and as repression lifts, painful affect and memories begin to emerge. The client's "flight into health " is a defensive maneuver.Answer A is incorrect: The client has probably not gotten better, but instead is in the process of deepening the work.Answer B is incorrect: The lifting of repression and the emergence of painful affect or memories does not indicate that the client is getting "worse." Rather, the client is beginning the process of "working through."Answer C is incorrect: There is no evidence to support the idea that the client's transference is interfering with the therapy. The correct answer is: Repression has lessened

A woman is recently separated from her husband and having a lot of difficulty coping. She uses "we" language a lot. What communication style is this? Select one: a. mind-reading b. placating c. triangling d. double-bind

This was a misleading question because its reference to "communication styles" implies that it is asking about Satir. As you can see, however, the Satir response does not match the question. Start by identifying what the woman is really doing and then use your "common sense" to find the best answer. Answer A is CORRECT: This woman's use of "we" implies that she is speaking for her ex-husband, who is not in therapy. Mind-reading takes place when a person makes assumptions about what another person is thinking or speaks for another person. Answer B is incorrect: Although this is a Satir response, it does not fit this situation. The woman does not appear to be discounting herself or trying to appease her husband or the therapist.Answer C is incorrect: This would be the best answer if "mind-reading" were not one of your choices. By talking about the two of them (e.g., herself and her husband), the woman is triangling her husband into the therapeutic relationship. Primarily, however, she is speaking for her husband. Also, triangling is not usually referred to as a communication style.Answer D is incorrect: There is not nearly enough here for you to conclude that a double-bind is occurring. The correct answer is: mind-reading

A young couple has been referred to you by a physician for treatment of a sexual dysfunction. They have no medical problems. What is your primary responsibility in this case? Select one: a. to give specific information on sexual practices b. to be a catalyst for communication c. to teach the couple specific techniques d. to determine which partner has the problem

When a case involves sexual dysfunction with no evidence of a medical condition or other physiological cause (i.e., when a medical exam has already been sought by the couple), your first intervention should be to encourage the couple to communicate. Note that the question asks what you (as a marital and family therapist) would do. Marriage and family counseling for sexual dysfunction addresses the interactions between the partners and stresses issues such as rigid rules surrounding sexuality, lack of open communication, attitudes toward sex, etc.Answer B is CORRECT: As a marital and family therapist, this would be your primary responsibility.Answer A is incorrect: Information about sexual practices and education about sexual techniques are provided in traditional sex therapy and would be appropriate interventions only if you were trained in sex therapy.Answer C is incorrect: The teaching of specific techniques should be left to a sex therapist.Answer D is incorrect: Although this suggests that you would seek additional information about the problem, which would be fine, it places too much emphasis on associating the problem with just one of the partners. You are treating a "couple" for sexual dysfunction and, therefore, should not attempt to place blame for the problem on one partner. In both marital and family therapy and sex therapy, the couple (or system) is viewed as the "patient" and it is inappropriate to "determine which partner has the problem." The correct answer is: to be a catalyst for communication

A therapist discovers that the grandfather in a family consistently sides with his 11-year-old granddaughter against the girl's mother (his own daughter). The therapist, a student of Jay Haley, would do which of the following? Select one: a. see the grandfather individually and help him understand the consequences of his actions b. "de-triangle" the grandfather, mother, and child by excluding the child from therapy c. see the mother and child in therapy and instruct the child to irritate the grandfather, and the mother to defend her daughter against the grandfather d. see all three together and instruct the grandfather to defend his daughter (the mother) instead of his grandchild

You needed to apply what you know about Haley's theory and technique to this clinical situation. Haley, a strategic therapist, proposes a circular model for explaining interpersonal events and, therefore, focuses on repeated sequences of behavior (e.g., vicious cycles). In this case, Haley would notice that the grandfather repeatedly sides with his granddaughter against the girl's mother.Answer C is CORRECT: Haley would most likely intervene as this answer suggests. Notice how this directive instructs the mother and daughter to behave in ways that are designed to break the family's behavior pattern. Haley uses such direct tactics (as well as paradoxical ones) to intervene into the family's circular patterns. This brings about new behavior patterns that can replace the old vicious cycles that operate in the family. Since Haley believes that changing the problem-maintaining behavior will resolve the problem, he views the task of therapy as changing the sequence of family events--if the sequence is effectively changed, the outcome (symptomatic behavior) will also change. As suggested in this answer, the tasks he assigns are often carried out between sessions (notice that the grandfather is not present in this answer, which implies that the directive will be carried out at home).Answer A is incorrect: As a strategic family therapist, Haley focuses on producing changes in behavior and, contrary to this answer, believes that the analysis of problems or attempts to change feelings are futile.Answer B is incorrect: Bowen, rather than Haley, would do this.Answer D is incorrect: Answer "c" better addresses all of the family's symptomatic behavior (i.e., all the players in the cycle) and, consistent with Haley's technique, assigns the mother and child a task to accomplish outside of session. Further, because Haley is concerned with family structure, his tasks more often address not only the presenting problem (which is all that is addressed in this answer), but also the family structure. The correct answer is: see the mother and child in therapy and instruct the child to irritate the grandfather, and the mother to defend her daughter against the grandfather

A schizophrenic teen is hospitalized. After several months, he is considered to be sufficiently recovered to return home. According to the concept of homeostasis, which of the following is least likely to happen? Select one: a. the parents will separate b. a younger child in the family will develop symptoms of Schizophrenia c. family rules will change to allow the family to support the recovered patient d. a previously functional family member will develop psychiatric symptoms

You were asked to pick the event that is least likely to occur. Homeostasis is a self-regulating process that maintains equilibrium in an organism or system; i.e., it is the tendency of a system to react toward restoring the "status quo" when change occurs.Answer C is CORRECT: The concept of homeostasis would predict the opposite of this. Rather than changing its rules to support the recovered patient, the family will behave in ways that restore the family to its familiar balance (i.e., one that includes a "sick member.")Answer A is incorrect: This might happen, as the child's recovery will upset the family's homeostatic balance.Answer B is incorrect: This might happen, as the family is accustomed to having a "sick member" and, thus, to maintain balance, someone in the family will need to be the "symptom bearer" (i.e., to signal or absorb the family's pain).Answer D is incorrect: This is likely, as it would serve to maintain the homeostatic condition. The correct answer is: family rules will change to allow the family to support the recovered patient