2021- Comp Exams Q

After returning from a tour in Afghanistan, an Army nurse reports having difficulty engaging with her friends and family, stating she no longer feels like herself and that activities that once gave her pleasure, no longer do. The therapist wonders if she may be suffering with PTSD. According to the DSM-5, in order to meet the criteria for a PTSD diagnosis, which of the following need to be met:

. All answers presented.

A family therapist is trained in the Solution-Focused model. What would be their primary therapeutic goal?

A perceptual shift from talking about problems to talking about solutions.

Vignette: A family enters therapy, having a 21 year old son who lives in the basement. He dropped out of college 2 years ago and is currently not working or going to school. He has refused all counseling. The father states he found evidence of marijuana smoking in his son's room. The mother states that the father and son argue and sometimes push each other. A 16 year old daughter is in high school but increasingly avoiding coming home.'Non-summativity' applies to this situation as follows:

A system has been created when the family was formed, but is now maintained by a pattern of inadequate communication and conflict.

A family is referred for therapy because their 14-year-old son has threatened suicide. His grades have dropped from honors to failing and he spends much time in his room. He has begun giving his things away and reveals to the therapist that he has thought about suicide and has a plan for how he would kill himself. The therapist should:

discuss their son's active suicidality and encourage them to take it seriously.

Structural and MRI Strategic differ in their orientation to all of the following EXCEPT:

emphasis on process over content.

When working with families presenting with an anorexic family member, Structural family therapists believe that anorexia nervosa is a problem that results from:

enmeshment

"Normal families have an evolutionary sense of time with emphasis on the process of becoming." This statement regarding normal family functioning is descriptive of which model of family therapy?

experiential

Beth and Paul come to counseling because Beth feels that after two years of marriage she and Paul have nothing in common. She complains that for the past six months she has been complaining to Paul that there are problems with their relationship. Paul states that he doesn't feel there are problems, he feels his wife is just overreacting. The therapist asks, "How does overreaction affect the relationship?" This type of question is a good example of getting the couple to:

externalize the problem.

Epston and White regard problems as something which influence or operate on people, rather than as something they're doing. The term for this is:

externalizing

Epston and White regard problems as something which influence or operate on people, rather than as something they're doing wrong. The Narrative technique utilized to accomplish this is:

externalizing.

Mr. Oesco comes to therapy with his son Josh. Mr. Oesco and his wife are divorced. He and Josh live together and Mrs. Oesco and her daughter Jessica live in another state. The presenting problem appears to be Josh's anger at his mother and his refusal to conform to the visitation arrangement set up by the court when the Oesco's divorced. Josh appears to have a good relationship with his sister which at times presents a problem to his father and mother.In assessing this family, a Behavioral family therapist would look at all of the following EXCEPT:

family life cycle.

Mr. & Mrs. Doherty present for family therapy complaining that their son Jon will not listen to them and is acting out. In assessing this family a Structural therapist would:

focus on current interactional patterns between family members.

The MRI model does not focus on:

functional nature of the problem.

A Mormon couple in Utah comes to therapy because they have become deeply committed to another partner and would like to add her as a wife. In the initial session it important to clarify

how the couple defines themselves as Mormons.

As a structural therapist you would most likely:

imitate family style and affect.

In brief prescriptive therapy, termination is:

initiated when the agreed upon number of sessions is up.

A therapist reports to her supervisor that a family she is seeing complains to her that she doesn't listen well to what they tell her. Her supervisor responds, "I'm sorry, what were you saying?" This is an example of a/an:

isomorphism

A therapist reports to her supervisor that a family she is seeing complains to her that she doesn't listen well to what they tell her. Her supervisor responds, "I'm sorry, what were you saying?" This is an example of:

isomorphism.

Vignette: A twelve year old boy told a friend in school that he was going to kill himself so that he didn't have to tell his parents about a recent poor test grade. The friend told a teacher who contacted the mother who became very upset on the phone. The teacher recommended an urgent appointment with a local family therapist. The boy has an older sister who has been in treatment for depression and a father who abuses alcohol. Before his initial interview with the boy, the clinician learns from the parents through a phone call, that although he did go home and tell his parents about the poor grade, he has repeated his suicide threat to other people, including to the clinician herself. From this new information the clinician concludes:

it is not good practice to determine the risk level from this information alone.

Bowen believed that functional shifts in differentiation often occurred during all of the following EXCEPT:

mishandling of attempted solutions.

One of the defining characteristics of the therapist's stance of the Narrative Therapy movement is its emphasis on:

neutrality

All of the following are characteristics of a double bind EXCEPT:

overt communication is protest.

A strategic therapist responds, "I understand why you want to stay with him" to a woman whose spouse has had multiple affairs. This response would be considered a(an):

paradox.

The structural technique of locating areas of possible flexibility and change in the family is called:

probing.

The stance of the therapist is that of coach for all of the following models EXCEPT:

psychodynamic

The essential feature of Anorexia Nervosa is:

refusal to maintain body weight.

According to Lyman Wynne, pseudo-mutual families may create a flexible yet unstable boundary called:

rubber fence boundary.

Known for his work with alcoholic systems, David Treadway suggests that a common coping mechanism for children in such systems is that of adopting certain rigid roles such as:

scapegoat, hero and lost child.

Relevant concepts of Bowen theory include all of the following EXCEPT:

search for strengths.

Mrs. K. spoke with Dr. Smith prior to the initial session, stating that Mr. K. was having an extramarital affair and the affair had become an explosive issue between them. Shortly into the first session Dr. Smith learned that Mr. K.'s affair was with a homosexual partner. After several sessions it became obvious that Mr. K. had no intention of stopping the affair. Dr. Smith stated that homosexual relationships were personally offensive to him and that therapy could not continue with him and he referred the couple to another therapist. Ethically, Dr. Smith:

should have sought consultation and dealt with the discriminatory bias.

A wife complains that her husband is upset because she refuses to have sex after a long day. She feels little or no sexual feelings when he approaches her at bedtime. However, when they are on vacation she has absolutely no problem reacting to her husband's advances; in fact, she is often the aggressor. The therapist diagnosis this as:

situational dysfunction.

Ethical concerns about offering "telephone therapy" do not include:

standard ethical prohibition against having dual relationships with clients.

_______________ generally focused more narrowly on hierarchical organization, and then only to the extent it is relevant to the solution of the presenting problem

strategic

Watzlawick would describe couples who are free to pursue careers and share childrearing and household chores as having a:

symmetrical relationship.

In a therapy session a husband implies that his wife appears to get her own way most of the time. The therapist then suggests that the husband say 'no' to the wife once during the following week. In initially assessing this client, a Strategic therapist would do all of the following except:

take a family history.

Mrs. S. came to therapy complaining that she has been unhappy and abnormal all her life. The therapist asked, "How do you know you are unhappy?" Mrs. S. expressed being unhappy with friendships and in her relationships with her family. The therapist then asked how Mrs. S. knew those unhappy feelings were not normal. Mrs. S. then mentioned some days in which she did feel happy. This attempt by the therapist to help Mrs. S. to identify exceptions is a technique used in:

the Solution-focused model.

Katherine asks her mother for candy at breakfast time. Her mother says "no" and Katherine continues to ask her mother. Each time her mother says "no", Katherine's whining becomes more persistent until she has a full-fledged tantrum, at which time her mother gives in so as not to wake her baby sister and Katherine stops whining. Katherine learns that if she whines enough she will get her way. In the above scenario:

the mother has been reinforced for giving in.

Solution-focused therapists prefer to focus on:

the past & future

Systemic couple therapy with patients suffering from depression is only indicated if:

the therapist has specialist training in systemic therapy.

Aeisha is a beginning therapist working with the Robinson family. The family is seeking treatment because their 15 year old son, was caught shoplifting. Aeisha feels like the family is challenging and resistant to her suggestions for change. In her next session, Aeisha spends more time joining with the family and asking how they thought therapy should proceed. After this session, Aeisha begins to reformulate an approach that is more consistent with the family's view of the problem. She soon discovers that movement is beginning to happen in therapy. According to research, Aeisha this family may have been presenting:

therapist resistance.

What is the purpose of licensure for Marriage and Family Therapists?

to maintain integrity of the profession.

A family consisting of a mother, father, two daughters age 13 and age 15, and a son age 17 enter therapy. The parents are complaining that their 15-year old daughter is coming in drunk every night and is very abusive to the family. The therapist takes the side of the daughter. This therapeutic technique is known as:

unbalancing.

An MFT uses space in the basement of her home to see clients. From time to time, her husband and children see the clients coming for appointments. In this situation the HIPAA Security Rule:

would indicate that no violation occurred because passing by residents of the MFT's home is considered part of a permitted disclosure.

All of the following emphasize the triadic process EXCEPT:

Nagy

A family therapist has in-session goals to accentuate the client's expression of attachment needs. Such emotional expression might be termed:

Primary Emotions.

According to research conducted by Beavers-Timberlawn, which family type is most at risk for domestic violence?

centripetal.

A technique developed by the Milan Model that utilizes a third person's perspective on a subsystem or other dyads within the system is known as:

circular questioning.

Who coined the phrase "tickling the defenses"?

Ackerman: called attention to avoidance and emotional dishonesty by provoking people to open up and say what's really on their mind.

The Object Relations approach to treatment of bulimia does NOT suggest which of the following?

All of the choices.

Maturano speaks of systems that can be controlled from the outside, similar to machines, as being:

Allopoietic Systems

Greenberg and Johnson's Emotionally focused couples therapy draws on:

Attachment Theory.

Family therapy with young children diagnosed with bi-polar disorder has demonstrated good results compared to control groups using medication or receiving no treatment at all. The most complete list of questions we should ask about this research is:

How was bi-polar defined, how was "good results" defined, how large was the sample size, what was the correlation, what was the statistical significance?

Olson's Circumplex Model of family functioning is based on the intersection of two basic family dimensions. They are:

cohesion and adaptability.

Studies have shown a reported decrease in delinquent behavior and positive change in family process when the families were involved in family therapy. A few studies comparing types of family therapies have found the following type of therapy to be most successful:

Behavioral-communication approach.

Family therapy would probably be the primary intervention choice for all of the following EXCEPT:

Borderline personality issues.

All of the following are similarities between Structural and Strategic except:

concern with the subsequent organizational structure of the family system.

A developmental task for families with preschool children is:

coping with energy depletion and lack of privacy.

When seeing a couple, a behavioral therapist asks the wife what her worst fear would be if she were to assert herself regarding her career. She responds, "If I assert myself about my career goals, my husband will leave me." The therapist does some reality testing using logical analysis and available data. This technique is known as:

de-catastrophizing.

Prescribing the symptom refers to:

Changing the meaning of a situation by the way it is perceived.

David Olson's Family Circumplex Model maps the dynamic relationships within families; identifying the following dimensions as critical to show how all family members and their behaviors are interconnected. Which of the following are Olson's dimensions?

Cohesion, Flexibility and Communication

"Conversational questions come from a position of not knowing and are the therapist's primary tool." This statement would most likely be made by a:

Collaborative therapist.

In a practice that includes over 50 active client families, a licensed marriage & family therapist bills only one client's insurance company through a billing service. All the rest of his clients are billed directly or pay at the time of the therapy. Some of the self-pay clients obtain insurance reimbursement using claim forms and/or billing statements signed by the therapist. In his disclosure statement at the beginning of treatment, the therapist would be wrong in stating:

I will not be transmitting any of your confidential information electronically for any reason. Therefore, the HIPAA Privacy Rules will not apply to our therapeutic relationship.

Clinicians looking for guidance from outcome research want to know if the model being tested works in real-world clinical settings. To respond better to this concern, the most important next step researchers should take is:

Include clients with dual morbidity in their studies.

Some research has demonstrated that there are certain 'common factors' in successful psychotherapy. Which of the following statements is correct?

It has been demonstrated that the common factor of "systemic/dyadic reformulation of the presenting problem," can be as important or more important that ideal choice of treatment model.

What would you do to enhance your work with a culturally different client?

Learn more about the culture through the client.

This therapy works to frame change in ways that reduce resistance, decrease dependence on therapy and bypass the need for insight while removing the presenting problem and allowing families to take full credit for changes achieved in therapy. This approach was devised by:

Milton Erickson.

A statement such as "Men only do anger" might be used as an example in which of the following models

Emotionally Focused CouplesTherapy.

In gathering information for an Adlerian Lifestyle Assessment of an adult female client, a therapist inquires about the client's sibling position and gathers details about the attributes of each of the client's siblings. The therapist is gathering information to assess the client's:

Family Constellation.

Beth and Paul come to counseling because Beth feels that after two years of marriage she and Paul have nothing in common. She said that for the past six months she has been complaining to Paul that there are problems with their relationship. Paul states that he doesn't think there are problems; he feels his wife is just overreacting. Which therapeutic model would directly confront Paul's pathologizing of Beth as problematic?

Feminist model

The Rodriquez family has been run like clockwork for the last 12 years. Mother and Father both agree that it is important to have clear rules in the family. But since the oldest daughter has turned 14, the rules are no longer working. An MRI therapist asks the family what they have done to solve the problem thus far. Father explains that they have increased the daughter's curfew from 9 to 10pm on weekends. This is an example of a:

First-Order Change

Circular causality speaks to the non-linear nature of systems. This concept originates from:

General Systems Theory and Cybernetics.

A family comes to therapy with a child problem which the therapist believes is actually a marital problem. The person least likely to focus on the marital problem early on in therapy is:

Haley.

In an Adlerian parenting class that you are facilitating, a parent expresses concerns about his seven year old daughter's behavior. He reports that his daughter consistently argues with him and fails to follow even simple behavioral directives. He provided an example from the past week in which she responded with open defiance when asked to set the table. In exploring the behavior with him, you learn that he often feels challenged and threatened in these interactions. He reports that he responds by fighting back and standing his ground which often intensifies the dynamic. Using Dreikur's concept of Mistaken Goals, you suggest:

He refrains from fighting but maintain his position by offering her limited choices such as how and when to set the table.

A family is referred to Kathy A. by the school for therapy because John, age12, is disruptive at school and has been diagnosed as having attention deficit disorder. The mother in her phone conversation with Kathy A. says how reluctant they are to start therapy again since the previous therapist had spent most of the time talking about the mother being too inconsistent and overprotective and the father being angry and uninvolved. They felt blamed and still found no relief for John. After meeting with the family and reading the medical reports, Kathy A. agreed with the diagnosis and decided to help the family and John understand about ADD and to teach them how to cope with it. She decided to use the following model:

Psychoeducational approach.

Susan, a 31 yr. old, African-American woman has begun therapy for the first time. Her therapist has explained to her how how important it is for her to come on a weekly basis, that this sort of continuity and regular meeting times is important to her feeling comfortable in therapy, allowing her to develop a sense of trust and safety so that she can express her most private thoughts without fear of consequence. This is an example of the therapist:

Setting the Frame

__________________ Family Therapy attempts to alter the family overall organization (boundaries, subsystems, coalitions, etc)?

Structural Family Therapy

Neuro-linguistic Programming, founded by Bandler and Grinder, was developed through:

Studying the work of Milton Erickson.

After reviewing the Security Rule, an MFT in an individual, private practice renting space in a large office building, decided he had to be much more careful protecting confidential records. He purchased locking file cabinets, password protected his client files on his computer, and added a confidentiality notice to all work-related emails and faxes. However he did not communicate with the cleaning service that enters his office in the evenings unsupervised. The following statement about these precautions is correct according to the HIPAA Security Rule:

The MFT was not required to contract with the cleaning service directly because he is exempted from this requirement by the Scalability Principle.

A case presentation in a peer supervision group addressed a family with multiple incidents of domestic violence presented by an MFT member. The husband was repeatedly violent in his efforts to control his wife's criticism of him. The wife frequently slapped the couple's 6 year old son, and the husband also used severe "corporal punishment" with their 11 year old daughter. The peer group was very concerned about this family. They took the family on as a group endeavor, with the goals of finding a safe and effective approach to helping them. Which of the following statements is correct?

The group recommended that the first step was filing a mandated report of abuse and neglect with the state social services department. A program of intensive family therapy was then put in place consistent with research findings which indicated that complex combinations of intimate terrorism, mutual violent control and violent resistance in families that can achieve safety and want to stay together, provides the best potential benefit.

A client was unhappy when he discovered that his therapist had disclosed his town of residence to a colleague during a peer supervision meeting. The meeting included an administrative assistant who was not a licensed mental health professional and lived in the same town as the client. The therapist's response to the client was to engage him in a conversation about his concerns and then proposed a clinical hypothesis suggesting the client was excessively fearful. The client did not accept this, and instead insisted that he did not want this kind of information disclosed to anybody without his written authorization. He claimed the therapist had violated his confidentiality under the HIPAA policies given to him at the beginning of his treatment. The client stated that he was embarrassed to be identified to the administrative assistant since she might have children in the same school as his, and that his residence should not be disclosed under these circumstances.

The therapist is still not in violation of HIPAA because his right to make use of an administrative assistant, is described in the Privacy Rule, and there is no exception listed for residence of clients and staff.

A husband and wife are in couples therapy. They both are experiencing depression at a level that is altering their lives. They have both experienced some improvement in depression and some improvement in their marital satisfaction. At their next session, they ask the MFT if they would be better off if they took time off of couples work and both entered separate individual therapies. From the perspective of current out come research alone:

The therapist should encourage continuing the couples therapy because there is research evidence that it is as effective or more effective in relieving symptoms of depression.

You are seeing a single father and his two children in therapy. You find yourself physically and sexually attracted to him. As an ethical family therapist, you should:

discuss the issue with a colleague in order to determine your objectivity and ability to continue working with the family.

An MFT in a 3-person group practice keeps her client PHI on her office computer. She uses clinical practice management software that keeps most information she needs conveniently organized. In addition to all insurance information, the software does her billing via direct internet connection to a payer clearinghouse, resulting in quick turn-around of payments, and also allows for email communications with the client, keeping the emails organized and associated with the client record. The software also provides a text entry area to record the session information. However, during her original clinical training, she developed the habit of scribbling a few notes on a pad next to her as she conducted her therapy sessions, which she still does. Her computer is password protected, she uses an encryption technology for all client and insurance company electronic/email transactions and her handwritten session notes are kept on paper and filed in a locked cabinet in her office. Two of the clinicians in the practice described above share the same family therapy case. One sees the parents in couples therapy, the other works with their 16 year old daughter individually, also offering occasional family meetings. The daughter often tells her therapist that there is information that she does not want disclosed to her parents.

The therapists can exchange HIPAA protected PHI without authorization from either parent because they are within the same covered entity.

Oldest children tend to gravitate to leadership positions and youngest children often prefer to be followers. The characteristics of one position are not "better" than those of another position, but are complementary. This concept comes from the works of:

Toman

In one study, OCD patients and their families were given psychoeducation sessions. The results were positive, but the sample size was small. Therefore:

We cannot generalize from this study to the broader population. We don't know if the positive effect will hold up when the same treatment is used in clinical settings.

An MFT reviews a study that concludes, "Of all the families included in this study, only 2 failed to achieve significant improvement and symptom relief by termination of treatment. A one year follow up, only 4 showed signs of return to their original symptomatic state." A proper conclusion from this information is:

We want to know if the reported findings can be considered representative of what a clinician would find when replicating the treatment in the general population. Therefore we need to check back in the research report for sample size, correlation and significance.

"The goals of family therapy are to establish the members' sense of belongingness and simultaneously to provide the freedom to individuate. In our system of therapy, social adaptation is not a goal: we seek to increase the creativity (what we call craziness) of the family and of the individual members." This statement was made by:

Whitaker.

Mr. & Mrs. Doherty present for family therapy complaining that their son Jon will not listen to them and is acting out. Which of the following would be a response by a Milan Systemic therapist?

Who in the family is most upset when Jon acts out?"

Bowen's concept of "differentiation" refers to:

a person's ability to differentiate feeling from thoughts.

The main difference between a 'situational' and a 'developmental' crisis is:

a situational crisis can happen at any time, but a developmental crisis is a predictable effect of going through life's psychosocial stages

A fundamental tenant of a Constructivist perspective is that language shapes reality. In Solution-Focused Therapy this notion was:

accentuated to stating that language creates reality.

A same sex couple comes to therapy because they are having problems regarding parenting their ten year old son. In the course of the first interview, it is clear that each parent has very different expectations for their son's behavior. A family therapist should treat the couple:

according to the problem being presented.

Blended families present unique circumstances for a therapist. Which of the following would be helpful to a family therapist in facilitating discussion:

addressing the boundary ambiguity often found when merging families.

A couple come into therapy because the wife has an absence of orgasm during intercourse. She reports that although she gets sexually aroused, she has never experienced an orgasm and is wondering what is wrong with her. The therapist diagnoses her as having:

anorgasmia.

A couple you have been seeing for a while come to you with a story about going to the playground with their 2 year old daughter. The mother allows her daughter to climb challenging courses up a rather tall structure while within arms reach. The father is upset at his wife for putting their child at danger and not seeing the potentially long term consequences of having a paralyzed child should she fall off.

ask the father to notice the developmental benefits his daughter gains when being physically challenged by age appropriate play, and to gauge her attitude and self-confidence after accomplishing a difficult task.

A couple comes to therapy because they feel their sex life is not satisfying. The female reports that she is always anxious and is unable to reach orgasm and feels that her husband thinks she is an inadequate sex partner. In the first session, a Bowenian therapist would do all of the following EXCEPT:

assess the inequality of power in the couple system and the extended family.

When working with a client, an Internal Family Systems therapist must be careful to avoid which of the following

b. Working with an exile before the system is ready c. Therapist assumes she/he is talking to person's Self and really is talking to a part d. Therapist thinks Self is doing the work, but it's really a part All choices offered

An MFT performs an evaluation at the request of a judge in a divorce case. In response to the court clerk's request for expediting the report, the clinician faxes the report to the court. The clerk calls back and states that the fax was not received, and they determine that it was sent to the wrong fax number. The MFT's fax machine report states that the fax was sent normally, meaning it was received by someone else's fax machine. The MFT cannot:

be held liable for a HIPAA violation because no PHI was sent.

You refer clients to a psychiatrist who keeps "stealing" your clients by referring them to a therapist in her group practice. You should:

call the psychiatrist to tell her why you refer clients to her making it clear you want your clients back.