MFT National Licensing Exam

A couple comes in for therapy. The husband complains his wife is too close to her family and she has trouble separating from them. In fact, he states that his wife is in constant contact with her mother and looks to her mother constantly to help her make decisions. Often these decisions are in opposition to decisions made previously by the husband and his wife. Which of the following questions would a Bowenian therapist as the husband? A: 'What was your mother's relationship with her mother and family?' B: 'What effect does your wife's closeness have on your relationship?" C: 'How have you tried to solve this problem in the past?' D: 'How many times per day does your wife contact her family?'

A: 'What was your mother's relationship with her mother and family?' Bowen hypothesized an orderly and predictable process connecting the functioning of family members across generations. The other answer can be eliminated as follows: 'What effect does your wife's closeness have on your relationship?' - Narrative; 'How many times per day does your wife contact her family?' - Behavioral; 'How have you tried to solve this problem in the past?' - Solution Focused.

Vaginismus is diagnosed in: A: a female experiencing painful spasms during intercourse. B: A female experiencing no desire for sex. C: A male or female experiencing genital pain during intercourse. D: a male or female experiencing anxiety during intercourse.

A: A female experiencing painful spasms during intercourse. Vaginismus is a recurrent and persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with coitus. Anxiety during intercourse is more directly linked to impotence or lack of desire, and male genital pain would not be defined as vaginismus.

Who coined the phrase 'tickling the defenses'? A: Ackerman B: Erickson C: Bateson D: Satir

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

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 the daughter to climb challenging courses up a rather tall structure while within arm's reach. The father is upset at his wife for putting their child in danger and not seeing the potential long-term consequence of having a paralyzed child should she fall off. A: 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. B: work with the mother to help her understand how the conservative viewpoint of her husband ultimately has the child's best interest and safety in mind. C: advise the mother and father to go to the playground separately so as to not confuse the child with the different parenting styles. D: report the mother to Child Protection Services for putting her child in danger.

A: 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. Challenging the father to explore gender roles and development aligns well with the goals of Feminist Family therapy. Men and women are often limited by their gender roles. A Feminist Family Therapist would challenge these gender-based assumptions. Note that this question addresses the Feminist model under the guise of a generic model question.

Greenberg and Johnson's Emotionally Focused Couples Therapy draws on: A: Attchment Theory B: Rational Emotive Therapy (RET) C: EMDR D: Conjoint Family Therapy

A: Attachment Theory Bowlby's Attchment theory, along with the works of Carl Rogers sevces as the theoretical underpinnings to EFT.

Systems that are self-organizing and self-maintaining, such as biological and human systems, are known as: A: Autopoetic Systems B: Circular Systems C: Allopoetic Systems D: Multi-directional Systems

A: Autopoetic Systems Designed by postmodern Chilean biologist, Maturana, systems that are self-organizing and self-maintaining, such as biological and human systems. Autopoetic Systems can be described by second-order cybernetics.

Your client of 9 months has been making slow progress after a major depressive episode. She reports that she is suddenly feeling better than she can remember, so good in fact that she has thrown out her old clothes and purchased a completely new wardrobe and feels like a new person. She further reports that she has quit her job and is soon planning a vacation to Hawaii and that this will be her last session with you. You should: A: Change your diagnosis and refer this client for a medication evaluation with a psychiatrist. B: Support your client on a job well done while going over all she accomplished in therapy with you. C: Remind the client that without continued therapy, her symptoms will most likely return

A: Change your diagnosis and refer this client for a medication evaluation with a psychiatrist. This question highlights that the original diagnosis of a major depressive episode is no longer sufficient. and that the rapid euphoria and mood swing is likely indicative of a hypo-manic state common to a Bipolar II disorder. This client should be referred to a psychiatrist for further assessment and medication evaluation.

Prescribing the symptom refers to: A: changing the meaning of situation by the way it is perceived. B: Refers to medication. C: Changing the meaning of a symptom by re-labeling it. D: Changing the meaning of a symptom.

A: Changing the meaning of a situation by the way it is perceived. For example, an obsessive spouse may e asked to increase his/her focus on his/her worries each day and keep notes on his/her worries, supposedly, so the therapist can learn more about the obsessive thoughts. The client either rebels and gives up the symptom, or obeys the therapist and increases the symptom thus putting the symptom under his or her control.

'Conversationtional questions come from a position of not knowing and are the therapist's primary tool.' This statement would most likely be made by a: A: Collaborative therapist B: Behavioral therapist C: Milan systemic D: Structural therapist

A: Collaborative therapist 'Not knowing' refers to the collabortive therapist's position, an attitude and beleif, that the therapist does not have access to privileged information and that people can never fully understand each other. From this perspective, the therapist always neds to be in a state of 'being informed' by the client, and needs to learn more about what has been said or not-yet-said.

Internal Family Systems believes all of the following EXCEPT: A: Communication theory can be applied to the internal system and with the ultimate goal of a 'parts party' as a means of integrating the four parts. B: Changes in the internal system will affect changes in the external system and vice versa. C: Systems theory can be applied to the internal systems. D: There are no 'bad' parts and the goal of therapy is not to eliminate parts but instead to help them find their non-extreme role.

A: Communication theory can be applied to the internal system and with the ultimate goal of a 'parts party' as a means of integrating the four parts. The notion of a 'Parts Party' comes from Satir.

Negative feedback is: A: Corrective B: entropic C: dysfunctional D: self-serving

A: Corrective Remember that in general systems theory, negative feedback is not the same as criticism. Negative feedback is when the thermometer 'tells' the furnace that it should stop sending heat because the desired temperature has been reached. Think of the 'negative' communication being as if the furnace asked: 'Should I do more of this heat-creating behavior?' and the thermostat answered 'No, discontinue what you are doing.' The thermostat is correcting the furnace's behvior.

A statement such as 'Men only do anger' might be used as an example in which of the following models: A: Emotionally Focused Couple Therapy B: Narrative Family Therapy C: Experiential Family Therapy D: Feminist Family Therapy

A: Emotionally Focused Couple Therapy A reliance on a Secondary Emotion such as anger might result in anger being substituted for a wide range of primary emotions.

A statement such as 'Men only do anger' might be used as an example in which of the following models: A: Emotionally Focused Couple's Therapy B: Narrative Family Therapy C: Experiential Family Therapy D: Feminist Family Therapy

A: Emotionally Focused Couple's Therapy This expression is an example of Greenberg and Johnson's concepts of Secondary Emotions.

The family therapists best known by the investment in spontaneity, creativity and risk taking are: A: Experiential B: Solution-Focused C: the Milan Group D: Strategic

A: Experiential Carl Whitaker and Virginia Satir, the two best-known Experiential therapists, repeatedly made the point that a therapist must be him/herself in the therapy. It is this 'authentic' interaction that they considered most influential in therapy.

Katherine asks her mother for candy for 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. The therapist suggests to Katherine's mother that she ignore Katherine when he whines. This technique used to eliminate behavior by not reinforcing is known as: A: extinction B: aversive control C: operant conditioning. D: assertive training

A: Extinction Discussion: Extinction occurs when reinforcement of behavior is withdrawn.

Beth and Paul come to counseling because Beth feels that after 2 years of marriage she and Paul have nothing in common. She said that for the past 6 months she has been complaining to Pual that there are problems with their relationship. Paul states that he doesn't think there are problems; he feels his wife is overreacting. Which therapeutic model would directly confront Paul's pathologizing of Beth as problematic? A: Feminist model B: Structural model C: Narrative model D: Milan-Systemic model

A: Feminist model Feminist Family Therapy challenges traditional family roles by questioning gender roles and their stereotyping and how these have affected the family. Pathologizing the female experience, as in the usual model codependency, is emphasized as problematic. Feminists work to move blame from an individual person to one's socialization process with special emphasis on the validation of the female experience )Bepko & Krestan, 1985). The other models are less likely to directly confront pathologizing.

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 10 PM on weekends. This is an example of a: A: First order change B: Second order change C: Third-order change D: None of the above

A: First order change Discussion: This is an example of first-order change - a change in behavior. While a second-order change is a change in the beliefs or rules that governs behavior or emotions.

A family presents with a 7-year-old chld who seems to look for his parent's acceptance and reassurance while answering every question the family therapist puts to her. When her parents express disagreement to what she has just expressed, she quickly adapts her position to that of her parents. This might be best described by of the following models: A: Framo's Object Relations Model B: Bowlby;s Attachment Theory C: Bowen's Model D: Minuchin's concept of enmeshment

A: Framo's Object Relations Model This vignette best describes Framo's construct of how the human need for acceptance is so great that a child will sacrifice her own ego identity in order to get that approval and maintain that relationship.

A family consisting of a lesbian couple and a 9-year-old son has been school refusing for the past year has asked for family therapy. In the first session, you notice that whenever the son speaks, one of his mothers is quick to finish his sentence. You adjust your chair as a therapist to block the mother and her attempt to speak for her son. You do this in order to address which of the following Bowenian concepts: A: Fusion B: Undifferentiated ego mass. C: Enmeshment D: Triangle

A: Fusion

The concept of the 'saturated family', the notion that the myriad of relationships, responsibilities, opinions, and choices make it difficult for individuals to have a clear sense of their desires and beliefs, was developed by: A: Gergen B: White C: Bateson D: Hoffman

A: Gergen Ken Gergen developed the concept of the Saturated Family and writes Extensively on the subject in his book of the same name. Lynn Hoffman, also a postmodernist, is best known for her historical treatise on the field of family therapy. Michael White is known for his work in constructionist/narrative theory, while Bateson first must be distinguished between Gregory and his daughter, Mary Catherine Bateson, who is also a postmodernist.

You tell a pushy, domineering father to continue making all the family decisions. You are clearly influenced by: A: Haley B: Whitaker C: Ackerman D: Penn

A: Haley Jay Haley is a founder of Strategic Family Therapy, which focuses on paradoxical and other indirect interventions. In this question, the symptom is being 'prescribed', one of the indirect interventions. Ackerman is one of the founders of family treatment and is known for applying psychoanalytic thought to families and using multiple family groups. Whitaker was known for using himself and his experience to put families into therapeutic crises, and Peggy Penn is a feminist therapist.

In an Alderian parenting class that you are facilitating a parent expresses concerns about his 7-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 asking to set the table. In exploring the behavior with him, you learned 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: A: He refrains from fighting but maintains his position by offering her limited choices such as how and when to set the table. B: He tells her that he loves her and that it is time to set the table. C: He helps her break the task of setting the table into smaller tasks and demonstrates how to set the table. D: He acknowledges overtly her hurt feelings to demonstrate that he understands her position about not wanting to set the table.

A: He refrains from fighting but maintains his position by offering her limited choices such as how and when to set the table. Dreikur's concept of mistaken goals utilizes several factors including a description of the child's behavior, a parent's feeling about that behavior, a parent's typical reaction, and the child's subsequent response to hypothesis 'the belief behind the child's behavior' and suggest alternative responses. The information that the daughter is arguing and no following directive, that father feels challenged and threatened, and that he responds by fighting which often intensifies the dynamic all point to the Mistake Goal of misguided power. With this mistaken goal, a child's underlying belief is that I only belong or count when I am in control and have power. Therefore an encouraging response from the parent can be to give a degree of power, such as limited choices.

In Bowenian family therapy, the main goal of treatment is to implement which of the following? A: Help one or more members toward a higher level of differentiation B: Encourage home visits during times of emotional upheaval or change. C: To obtain a family history D: Help members understand their roles in the family system.

A: Help one or more members toward a higher level of differentiation. Discussion: Bowen believed that the goal of treatment was to increase the client's level of differentiation i.e. their ability to differentiate between thoughts and feelings.

Which of the following therapists believe that when treating alcoholics the goal of reduced drinking is only an appropriate goal, if it is also a goal of the clients? This therapist may also state that the more traditional concepts of the disease model may, in face, be counterproductive for many alcoholic clients. A: Insoo Berg B: David Treadway C: T.J. O'Farrell D: Michael Elkin

A: Insoo Berg Over the years, a variety of skills clinicians have described their approaches to family therapy with alcoholics. Most emphasize the importance of working collaboratively with 12-step programs such as A and Al-Anon, and consider abstinence to be the only appropriate foal for therapy with alcoholics. An exception to this is Berg's and Miller's application of Solution-Focused Therapy to alcoholics. They consider reduced drinking to be an appropriate goal of the client. They also maintain that many of the more traditional concepts of the disease model, e.g. 'Alcohol is a disease', 'Once an alcoholic always an alcoholic' may, in face, be counterproductive for many alcoholic clients (Piercy & Sprenkle, 2nd edition, p. 321).

A Milan-Systemic therapist would define the purpose of circular questioning as: A: Learning more about differences in family members' perceptions of their relationships. B: expanding on the notion of a reframe. C: disrupting the multiple interactional sequences existing in the family. D: an individualized prescription of an action or series of actions designed to alter the family's roles.

A: Learning more about differences in family members' perceptions of their relationships. Circular questioning is a series of questions asked of one family member about another or about the relationships within the family. Other answers can be eliminated as follows: Disrupting the multiple interactional sequences - invariant prescription; Expanding on the notion of a reframe - positive connotation; Individualized prescription of an action - rituals.

A doctoral candidate had difficulties meeting his deadlines due to procrastination. He reports to his therapist his fear of doing a poor job. The therapist responds by telling him to write one chapter in his usual way, and in writing the next to submit only a quick first draft. The quick first draft chapter received praise and acceptance and the problem-maintaining sequence was broken. This therapist most likely was trained in the: A: MRI approach B: Behavioral Approach C: Narrative Approach D: Psychodynamic

A: MRI Approach Consistent with Bateson's (1972) concern about over-intervention, the MRI approach is a minimalist one. Treatment goals may not involve changing the family at all. The MRI therapist may look at the problem-maintaining sequence within an individual and break it. The other answers can be eliminated as follows: Behavioral approach would use operant conditioning to associate completing a project while a rewarding experience. A Narrative approach would involve self-report history (biography) of handling deadlines and/or externalizing 'procrastination' as a force invading and compromising the well being of the client. A Psychodynamic approach would work to achieve insight into the meaning of the procrastination.

Historically, the theory most associated with brief therapy is: A: Milan Systemic B: Erickson C: Structural D: Experiential

A: Milan Systemic The original Milan model epitomized the brief MRI model. The Milan Systemic model specified few and far-spaced sessions. Other answers can be eliminated as follows: Structural does not specify anything about the number of sessions and Milton Erickson's work was brief but was not strictly a 'theory as specified in the question. It would be the best answer if Milan Systemic was not available on the list of answers. The Experiential model is not known to be brief.

Couple therapy has been shown to be effective when: A: one member of the couple is depressed and conflict is high. B: One member of the couple is anxious and conflict is high. C: There is minimal depression or anxiety, but the conflict is high. D: One member of the couple is depressed and conflict is low.

A: One member of the couple is depressed and conflict is high. This is the correct finding. Couple therapy has also been found to be the best treatment for dealing with couple distress. However, the research finding is somewhat weakened by the lack of objective measures of depression. Most studies have used self-report only.

Mrs. J. called a Bowenian therapist and told him she wanted to set up an appointment to include herself, her husband, and their daughter, Mary, age 3 who was a behavior problem. Milton Erickson's influence on Strategic family therapy included all of the following except: A: organizing the family hierarchically B: client change being the responsibility of the therapist. C: emphasis on brief therapy. D: utilizing therapeutic paradox.

A: Organizing the family hierarchically. Erickson's influence on Haly included all but organizing the family hierarchy. Thinking hierarchically was Minuchin's influence.

A family comes to therapy because their son has just been diagnosed as schizophrenic. The parents report that the hospital report alluded to the fact that their son's schizophrenia was caused by the family's dysfunction. The therapist states that schizophrenia is genetically based and that the family had 'no control over it'. This therapist is MOST LIKELY coming from which model? A: Psychoeducational B: Strategic C: Milan Systemic D: Mental Research Institute

A: Psychoeducational Discussion: The psychoeducational model was born of dissatisfaction with both traditional family therapy and psychiatric approaches to schizophrenia. Carol Anderson, Douglas Reiss, and Gerald Hogarty focus on the devasting impact of schizophrenia on family systems, rather than the possible effects of preexisting family characteristics on either the onset or maintenance of the syndrome.

Research has found that the most effective treatment of children with conduct disorders, both aggressive and non-aggressive, has been: A: Psychoeducational model B: behavioral contracts C: the Structural approach D: extreme directives

A: Psychoeducational model Patterson and colleagues have found parent management training to be more effective than no treatment, and the effects of treatment have been maintained at follow-up of up to 18 months. Parent training involved a variety of treatment procedures including didactic instruction of the parents in social learning principles.

A couple comes to therapy because heir three-year-old daughter is 'out of control'. During the session the wife begins complaining that her husband is never home and she is left to deal with her daughter's behavior. During the first interview with this family, the first priority of a Strategic Family therapist would be: A: set goals B: focus on the couple interaction C: focus on the child. D: improve communication.

A: Set goals. The first priority of the initial interview is to set goals of treatment. Haley would not focus on the couple directly, but indirectly by having them work together towards a goal.

In a large scale study, over 24% of all couples indicated they experienced some form of violence, and of those, half experienced reciprocal violence. This finding toether with other similar findings has led to the reformulation of domestic violence into 4 subtypes. Which of the following statements is correct? A: Situational violence can be severe, but does not repeat as much as intimate terrorism. B: intimate terrorism is two sided. C: Situational violence is not as bad as intimate terrorism. D: Violent resistance is an acceptable response to intimate terrorism.

A: Situational violence can be severe, but does not repeat as much as intimate terrorism. Discussion: This is correct. Although it arises as a result of a stressful situation, it can nevertheless be severe and dangerous. It does not repeat as a manifestation of the couple dynamic as much as intimate terrorism or mutual violent control.

A couple comes in for therapy. The husband complains his wife is too close to her family and she has trouble separating from them. In fact, he states that his wife is in constant contact with her mother and looks to her mother constantly to help her make decisions. Often these decisions are in opposition to decisions made previously by he and his wife. After hearing the husband's statement, the therapist says, 'You really care about your wife and don't want to lose the relationship you have'. Which model is the therapist most likely following? A: Strategic B: Collaborative C: Behavioral D: Solution-Focused.

A: Strategic This statement is a positive reframe, a Strategic technique in which choice of language and labeling of vents is used to give new meaning to a situation.

Mr. & Mrs. Kelly seek therapy from a behavioral family therapist because their 7-year-old daughter Kristen typically refuses to go to bed until after 10 PM. The therapist would: A: Suggest that the child be put into time out. B: Ask 'How does this make you both feel?' C: ask 'Who in the family is most upset when Kristen does not go to bed?' D: explore the sleeping habits of both parents when they were children.

A: Suggest that the child be put into time out. Discussion: The options are associated with the following models: Circular questioning (who in the family is most upset when Kristen does not go to bed?), transgenerational (explore the sleeping habits of both parents when they were children), and experiential (How does this make you both feel)

A couple comes to therapy because the woman is having problems 'being sexual'. The therapist gives a sensate focus homework assignment. During the next session, the woman comments that she couldn't allow her partner to touch her. What did the therapist fail to do? A: take an adequate sexual history from the couple. B: acknowledge the partner's ambivalence C: Start off with a stop-start technique D: send the woman for a medical examination.

A: Take an adequate sexual history from the couple. A major element in many sexual treatment programs is the sexual history interview (which is not the same as a family or individual history). Information gathering during sexual history-taking can be useful in building rapport and in enabling the clinician to establish initial working hypotheses about the etiology and working maintenance of the sexual problem in a particular case. (Gunman and Kniskern, Handbook of Family Therapy, Vol 1, p. 602). For example, in this case, it is possible that the woman may have been sexually abused. This is information that might be obtained in the course of taking a sexual history. While most experienced marital and sex therapist, the question does not specify that one was taken. It, therefore, is possible that it was not taken especially given the unexpected result of the homework assignment. Further, 'sexual history is also the best answer because the remaining answers can each be eliminated for the following reasons: 'acknowledge the partner's ambivalence' - it wasn't the partner who was having trouble being touched. 'Send the woman for a medical examination' - a medical exam was not indicated because there is no indication that she was having pain or any organic problems. 'Start off with a stop-start technique' - this is a technique used for the treatment of premature ejaculation. It would be not be used for a woman with problems participating in sex.

An MFT is a 3-person group practice that keeps her client's PHI on her office computer. She uses clinical practice management software that keeps most information she needs consistently organized. In addition to all insurance information, the software does her billing via a direct internet connection to a payer, clearinghouse, resulting in the 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 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. According to the HIPAA Security Rule's Administrative Safeguard standards: A: The clinician is in violation unless she has documented the security measures she has taken to prevent unauthorized access to her files and her computer. B: The clinical is not in violation because the Safeguards principle provides an exception for small practices. C: The clinician is in violation because therapy notes must be kept with PHI and easily accessible in case the client requests them. D: The clinical is not in violation because she has taken the recommended and required steps outline in 'Physical Standards'.

A: The clinician is in violation unless she has documented the security measures she has taken to prevent unauthorized access to her files and her computer. The Security Rule requires that all steps taken to secure PHI be documented. Documentation means a separate written record of steps taken and explanation for decisions to not take any steps that were not reasonable in the clinician's circumstances. Even the most meticulous safeguards of computer access and file cabinet locks, would not satisfy the HIPAA requirements if there were no separate documentation of these measures. She is providing reasonable security for her client's PHI, but would be in violation if there were no documentation.

An MFT read a report of research that concluded by saying 'this study demonstrates that our model is efficacious.' Which of the following statements is correct? A: The study has shown that the treatment method used will work in controlled experimental settings with carefully trained clinicians following a detailed plan. B: It is unknown from the information given, what conclusions can be drawn from it for clinical settings. C: The study has shown that the treatment method used will work in some but not all real-world clinical settings. D: The study is qualitative, not quantitative, and therefore cannot be used in real-world clinical decision-making.

A: The study has shown that the treatment method used will work in controlled experimental settings with carefully trained clinicians following a detailed plan. Discussion: This is the correct definition of 'efficacious'.

An MFT working at a clinic as a 'fee-for-service clinician stayed home sick one day and needed to cancel her appointments. She called the administrator who offered to have the clinic's telephone receptionist call all her clients to cancel. The clinic administrator gave the receptionist client folders for each of the MFT's clients scheduled that day and asked her to make all the calls. While she was on the phone with the mother of one client, the receptionist asked about her son by name, having come across it in the client's file. The mother was uncomfortable with the receptionist's conversation and later complained to the MFT directly about releasing confidential information unnecessarily, in this situation: A: The use of the son's name was a violation of the HIPAA Privacy Rule's principle of 'minimal information necessary.' B: The use of the son's name was appropriate because he was one of the clients. C: Unlicensed workforce members should not be handling confidential information. D: The administration took full responsibility for managing the phone calls and therefore the MFT cannot be considered responsible for improper disclosure.

A: The use of the son's name was a violation of the HIPAA Privacy Rule's principle of 'minimal information necessary.' Discussion: While disclosures and other uses of PHI are allowed for normal healthcare operations, HIPAA's 'minimal necessary' principle dictates that no more information should be disclosed than is absolutely necessary to complete the function being performed. It was not absolutely necessary to mention the son's name, thereby raising the mother's concern that a looser interpretation of confidentiality was in force in the clinic. There is nothing in question that indicates that the use of the son's name was necessary to reschedule the appointment. Eben if the son was attending the appointments, which is not clear from the question if the rescheduling can be completed with the conversation with the mother alone, the discussion of the son would be beyond minimal necessary disclosures. If the son were one of the clients, over 18, and the mother requested that the receptionist make a separate call to him to reschedule, then the discussion of his name would have been necessary.

'The goals of family therapy are to establish the members' sense of belongingness and simultaneously to provide freedom to individuate. In our system of therapy, social adaption 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: A: Whitaker. B: Nagy. C: de Shazer. D: Bowen.

A: Whitaker. Whitaker is known for his therapeutic use use of 'his craziness' in the Experiential model.

A therapist on a reflecting team recognizes the parents of the family coming in for therapy as former college classmates. She should: A: withdraw from the reflecting team. B: say nothing C: ask the family if they object to her participating. D: discuss this with her supervisor at their next meeting

A: Withdraw from the reflecting team Discussion: When a pre-existing relationship exists between a client and therapist, it will alter the integrity of the treatment, so in this situation, the therapist must withdraw themselves.

A family is referred to Kathy A. by the school for therapy because John, age 12, 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 ADD and to teach them how to cope with it. She is decided to use the following model: A: a Psychoeducational approach B: Strategic approach C: an Experiential approach D: Behavioral approach

A: a Psychoeducational approach Discussion: Anderson and her associates describe the Psychoeducational model as a directive intended to provide families with 'support, information, structure, and specific coping mechanisms. The assumptions on which the model is based are: that the identified patient is a true patient by virtue of having a core biological deficit to produce overtly in all disturbed behaviors and cognitions. Key in all Psychoeducational approaches is the empowerment of the patient family system through increased knowledge around the illness and teaching increased skills in dealing with the medical and other social systems.

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 that there are problems, he feels his wife is just overreacting. In assessing this couple, A Strategic Family Therapist would: A: assess Beth and Paul's attempts to solve the problem. B: affirm all efforts at positive structural changes. C: use a genogram construction to help the couple identify family of origin patterns. D: strengthen the martial subsystem

A: assess Beth and Paul's attempts to solve the problem. The attempted solution that becomes the problem is a hallmark concept of the MRI branch of the strategic model. The other answers can be eliminated as follows: 'affirm all efforts at positive structural change'. Behavioral 'use a genogram construction to help the couple identify family of origin patterns'. Intergenerational 'strengthen the martial subsystem'. Structural.

According to Bowen's theory, the extent to which one's emotional and intellectual systems are distinguishable is called: A: differentiation of self. B: individuation. C: family projection process. D: multi-generational transmission process.

A: differentiation of self. There are all Bowenian terms.

When assessing refugee families, all of the following are essential elements a family therapist all of the following except: A: disparity in sex role expectations B: family strengths and support system C: acculturation stress D: migration stress.

A: disparity in sex role expectations Assessing migration stress and acculturation stress of a family and then understanding their strengths and support networks are primary for a therapist working with refugee families. While a difference in sex role expectations between the culture of their country of origin and their new home would be one aspect of acculturation stress, it is not usually a primary an issue because some continuity of sex role expectations is kept between a couple of similar background. Disparity in sex role expectations is more common in interracial couples rather than refugee families.

A family consisting of a mother, father, and two daughters ages 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. A family therapist first observes the family over the course of a session. A family therapist first observes the family over the course of a session and then intervenes to change the dysfunctional transaction patterns. This technique is known as a(n): A: enactment. B: Paradox C: reframe D: positive connotation.

A: enactment Discussion: An enactment is a punctuation of a behavioral sequence amongst family members. It can be used diagnostically or paradoxically by drawing attention to a particular pattern of the behavioral interchange.

Systemic therapy has been shown to be effective in the treatment of: A: encopresis and conduct problems in children. B: schizophrenia and BiPolar disorder C: anxiety disorders and OCD in adolescents. D: adult personality disorders and associated family problems.

A: encopresis and conduct problems in children. Family Systems therapy has been show to be particularly effective in working with encopresis and conduct disorders in children.

A family is referred for therapy with a family therapist in private practice. The daughter, the IP, has asked to speak with the therapist privately. During the conversation with the therapist she announces that she is pregnant. In this situation, the most appropriate initial approach for the family therapist would be to: A: encourage the daughter to talk to her family about her situation. B: refer the daughter to an individual therapist and continue family therapy. C: offer to counsel her as to whether she wants to keep the baby or abort. D: tell her you can't keep her secret and that you will have to tell her parents.

A: encourage the daughter to talk to her family about her situation. From a family perspective, such need for such a secret would have certain important assessment potential as to how the family is structured. Also, important to note, a 16-year-old has the right to keep certain information from her family if she so desires.

Mr. & Mrs. Doherty presents 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: A: focus on current interactional patterns between family members. B: operationally define the problem behavior including duration, frequency, and intensity. C: listen to each family member's story of the problem, casting it into a framework of obligations and entitlements to determine levels of trustworthiness in the family. D: assess information about each person's willingness to be part of the therapeutic process.

A: focus on current interactional patterns between family members. When assessing a family a Structural therapist focuses on interactional patterns, (verbal and non-verbal), boundaries, subsystems, hierarchies, alliances, etc. the other answers can be eliminated because they represent assessment approaches of other models as follows: 'listen to each family member's story of the problem, casting it into a framework of obligations and entitlements to determine levels of trustworthiness in the family' - Contextual; 'assess information about each person's willingness to be part of the therapeutic joining process' - Solution-Focused; 'operationally define the problem behavior including duration, frequency, and intensity' - Behavioral.

In the course of therapy with a single-parent mother (age 54) and her adoptive daughter (16) who has a history of bulimia, the therapist reinforces with praise both mother and daughter's success over the past week of not listening to bulimia. The therapist then asks the daughter to make contact with the person in her life this next week who would be least surprised at her success. This technique is called: A: historicizing unique outcomes. B: collapsing time. C: mapping the relative influence of the problem. D: restorying the subjugated narrative.

A: historicizing unique outcomes. This is a good example of how a Narrative therapist would generate a unique outcome bringing the daughter to a place where she received support from those in her support system that believe in her ability to not listen to bulimia.

A family consisting of a mother, father, 2 daughters, ages 13 and 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. During the first interview the therapist begins the session by greeting each family member and asking each member to tell her a bit about themselves before asking for his/her view of the problem. The therapist would be: A: joining B: mimesis C: boundary making D: accomondating

A: joining This is a clear example of how a Structural therapist would begin the joining process. One makes a personal connection with each family member to start joining before moving into defining the problem.

According to a Behavioral therapist, a therapeutic intervention might be designed to do all of the following except: A: looking at the ways the family will resist change and the ways the family will take charge of their own growth. B: probe for the stream-of-consciousness thoughts and visual images held by each member of the couple or family system when describing past events that elicit negative affect. C: have each member write a self-report logs listing complete records of daily dysfunction thoughts, upsetting marital/family interaction, etc. D: encourage the spouses to interact during the session.

A: looking at the ways the family will resist change and the ways the family will take charge of their own growth. This is an exception question. Look for the answer reflecting an approach that a Behavioral family therapist is generally brief, focusing on the presenting problem, and is also ahistoric. Behaviorists are not interested in resistance and growth, and tend to focus on symptom removal. All of the other answers reflect elements of the Behavioral model.

A family comes to therapy because their ten-year-old child is stealing money from them. After three sessions, the stealing stops and the family decides to terminate therapy. A Collaborative therapist would. A: maintain input from all members of the system, including him/herself, and mutually determine if therapy should end. B: say they have not had appropriate time to rewrite the story. C: ask the family to rate on a scale of 1-10, how they feel the problem is now compared to when they came in. D: accept termination as an indication that the family's perception of the problem had changed.

A: maintain input from all members of the system, including him/her self and mutually determine if therapy should end. In Collaborative therapy, frequency, duration, and termination of sessions are determined and negotiated on a session-by-session basis with input from all members of the family and therapy team.

A feminist critique of research into therapy outcomes would include all of the following EXCEPT: A: measures are based on male data. B: no one has asked women how they feel about therapy. C: research does not use gender sensitive measurement. D: the perople doing the research are all males.

A: measures are based on male data. Discussion: Measures are based on marriage and family therapy, not only on males

As a family therapist influenced by the work of Milton Erickson, you would advocate: A: paradoxical intention B: direct suggestion. C: teaching coping skills. D: helping client to work through psychic conflict.

A: paradoxical intention. Milton Erickson was known for his creative and bold paradoxical techniques. Jay Haley and other Strategic therapists, as well as the NLP theorists, studied his work closely and built upon it. Direct interventions are less common among Strategic theorists, as are insight, working through and coping skills.

Children adapt most easily to remarriage if they are: A: preschoolers - either sex B: adolescent boys C: adolescent girls. D: None of the above

A: preschoolers - either sex The younger the child, the more easily they adapt to change according to David Schnarch.

A couple comes to therapy and after a few sessions they agree that if the husband comes home from work by 7 p.m. at least 3 nights a week the wife will make arrangements for the couple to go out on Saturday nights. A behaviorist therapist would call this type of contract: A: quid pro quo B: credit balance C: time-out D: shaping

A: quid pro quo The quid pro quo contract is a type of contingency contract whereby one spouse agrees to make a change after a prior change by the other.

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: A: scapegoat, hero, and lost child B: pleaser, placater, blame, irrelevant, and congruent C: mover, opposer, follower, and bystander D: none. Treadway has not posted any roles for children

A: scapegoat, hero, and lost child. Treadway has posited that children who grow up in alcoholic systems need various survival skills in order to cope with the unpredictability of these systems. Rigid roles such as hero, scapegoat, and lost child may get children through such craziness but do so with a toll in later life. Please, placater, etc., is from the work of Virginia Satir, Mover, opposer, etc., is from Kantor and Lehr. SG, Chapter 26, key: Treadway, substance abuse, alcoholic systems, roles.

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: A: should have sought consultation and dealt with the discriminatory bias. B: was well within his rights and did not have to see the couple on the grounds that he found homosexual relationships offensive. C: should have continued to see the couple and kept his discriminatory bias to himself. D: should have brought the homosexual partner into couples therapy and dealt with the triangle.

A: should have saught consultation and dealt with the discriminatory bias. When Dr. Smith refused to continue professional service to the couple because of Mr. K's sexual orientation, a violation of the AAMFT ethics code occurred. Sexual orientation is the latest addition to the non-discrimination provision of the Code. As with any value conflict between therapist and client that threatens the quality of service, the therapist first should have sought consultation and dealt with his discriminatory bias. Only if unsuccessful, should the therapist have revealed the bias to the client and the likely influence it might have on the therapy. The therapist could have offered to refer at the time so the client could make an informed decision about whether to continue with him, (Brock, Ethics Case Book, p 54).

After 9/11, the US responded to the attack with the invasion on both Afghanistan and Iraq. A systemic concept that addresses this knee jerk approach to solving a problem (9/11 attack) by offering a solution focused only on the symptom rather than the root cause of a much bigger issue in te world (effects of US colonialism is: A: societal regression B: multi-international partiality C: every action results in a similar reaction D: quid quo pro

A: societal regression Bowen looked beyond families into society and felt at times larger social issues in society were often given 'Band-Aid solutions' which missed the core systemic structures that had resulted in the problem, coining the concept of societal regression.

A family therapist is working with a family of a mother and father whose children refuse to listen to them. She decides to use the miracle question with the family. How would she begin introducing it? A: suppose one night you were asleep, a miracle happened and your problem was solved. Upon waking, what would be the first thing you would notice that would tell you that the miracle had occurred? B: Suppose one night you solved your problem. The next morning, rate on a scale of 1-10 how successful the miracle was and how you came to this rating. C: Suppose a miracle happened and you had the power to change this situation. How would you know it was truly the right situation to change with this new power? D: All of these could be modified miracle questions. It is used to activate a problem-solving mindset by giving people a vision of their goal.

A: suppose one night you were asleep, a miracle happened and your problem was solved. Upon waking, what would be the first thing you would notice that would tell you that the miracle had occurred? Only response 3 sets of correct context for the miracle to occur.

According to Jellinek's theory of Progressive Phases of Alcoholism, the phase associated with gross drinking behaviors, blackouts, gulping, and sneaking drinks is: A: the Prodromal Phase B: the Chronic Phase C: the Experimental Phase D: The Pre-Alcoholic Phase

A: the Prodromal Phase Jellinek has developed a progressive model for Alcoholism: Pre-Alcoholic Phase, Prodromal Phase, Crucial Phase, and Chronic Phase. The Prodromal Phase begins when the drinking is no longer social but becomes a means of psychological escape from tensions, problems, and inhibitions. Although the eventual problem drinker is still in reasonable control, their habits begin to fall into a definite pattern: 1) Gross Drinking Behavior: They begin to drink more heavily and more often than their friends. 'Getting wasted' becomes a habit. When drunk, they may develop a 'big shot' complex, recklessly spending money, boasting of real and imagined accomplishments, etc. 2) Blackouts: A 'blackout', temporary loss of memory, is not to be confused with 'passing out', or loss of consciousness. The drinker suffering from a blackout cannot remember things they said, things they did, places they visited while carousing the night before - or for longer periods. Even a social drinker can have a blackout. With prospective alcoholics, the blackouts are more frequent and develop into a pattern. 3) Gulping and Sneaking Drinks: Anxious to maintain a euphoric level, they begin to pass off drinks at parties and instead slyly gulp down extra ones when they think nobody is looking. They may also 'fortify' themselves before going to a party to ensure their euphoria. They feel guilty about this behavior and skittishly avoid talking about drinks or drinking.

A woman reports that she wants to be close to her husband and do more things together, but every time she broaches the subject he seems to distance himself even more. As a transgenerational therapist you detect a pursuer/distancer pattern. If you wanted to increase intimacy with this couple, you would most likely recommend: A: the pursuer distance themselves from the distancer. B: the distancer distance themselves from the pursuer. C: the pursuer pursue the distancer. D: the distancer pursue the pursuer.

A: the pursuer distance themselves from the distancer. Discussion: Tom Fogarty, a Bowenian theorist, posits the fixed distance that exists between a distancer and the pursuer. As one moves closer or away, the other adjusts to maintain the fixed distance. Hence, a pursuer must move away to move the distancer closer to intimacy.

A COntextual family therapist interviews a family and discovers that Mr. Medieros, the father, comes from a family in which his father was irresponsible and unavailable. Mr. Medieros reports that as the eldest son, he took responsibility along with his mother for the well-being of the family. Mrs. Medieros smirks and states how ironic it is that her husband withdraws from her and her children. In obtaining this information, the therapist is able to see: A: the transgenerational issues and destructive entitlement. B: the disloyalty Mr. Medieros felt toward his family of origin. C: the triangulation of Mr. Medieros by his mother. D: the level of differentiation from both his family or origin and his nucleus family.

A: the transgenerational issues and destructive entitlement. This vignette demonstrates the trans-generational issues and destructive entitlement in terms of a revolving state of injustices. Mr. M. comes from a family in which his father was irresponsible and unavailable. Since he supposedly took on his father's role, he most likely feels justified in his present role, feeling he deserves a quiet and calm life for his earlier sacrifice. Other answers can be eliminated as follows: Triangulation is either Structural, Strategic, or Bowenian, but not likely Contextual. Mr. Medieros felt loyalty, not disloyalty. Differentiation is primarily a Bowenian concept.

when a therapist decides to close his/her practice and the client wishes to continue with treatment the therapist should provide at least ____________ referrals. A: Three B: One C: The therapist is not obligated to offer referrals. D: Two

A: three When closing a practice a therapist must follow state and federal laws governing closing a practice and the maintaining of records. In general, a therapist should provide 3 referrals.

A Saudi family who has been in the US for 7 years comes to your office for an initial session. They have come to family therapy because their eldest son who is 15 has become defiant, speaking back to both parents, and was recently caught cutting school. The father and mother are at odds around how to deal with the son. The mother states that this is normal for boys in the US to behave this way while the father wants to impose much more stringent discipline and supervision of the boy, restricting him to the house when he is not in school. The initial goal of the therapy should be: A: working towards strengthening parental subsystem so that they might parent as a more unified front. B: joining with the mother as she is more in synch with normal adolescent development. C: immediately join with the father given that Saudi families are patriarchal and success will be tied to his following your guidance. D: teaching the family about acculturation and developing strategies to help them better understand American culture.

A: working towards strengthening the parental subsystem so that they might parent as a more unified front. This question initially presents with ethnicity and acculturation-related issues, yet as you read on it is clear that the parents are not on the same page regarding how to deal with their son. A family therapist must always take into account a family's ethnicity and how this influences the family structure, yet it is clear that the best answer related to the therapy initial goal is to work on unifying the parents so that they can work together to come up with a means to approach their con. Joining with either parent will only further the split and a psycho-ed approach at explaining adolescent development while helpful would not be the first goal of the therapy.

A family comes to therapy because the 30-year-old son, who is a Gulf War veteran, guards the perimeters of the house during the middle of the night. This behavior is upsetting to the parents and they want the son's behavior to stop. A strategic therapist suggests that the parents plan times throughout the night with the son to make sure the house is secure. Within two weeks, the son no longer gets up to check the house. The therapist then suggests the son begin looking for his own apartment. The filmy stops coming to therapy, What statement might a Strategic therapist make about the family terminating therapy? A: 'I shose the incorrect core structure.' B: 'The therapy was successful.' C: 'The family wasn't really ready for change.' D: The first stage of therapy, symptom relief, was completed successfully.'

B: 'The therapy was successful.' Strategic therapy is oriented toward resolution of the presenting problem, therefore the therapy was successful and complete.

Originated by postmodern Chilean biologist, Maturana, systems that are self-organizing and self-maintaining, such as biological and human systems. Autopoietic systems can be described by: A: equipotentiality B: 2nd order cybernetics C: chaos theory D: circular causality.

B: 2nd order cybernetics This is the classic definition for an autopoietic system which can often be described by second-order cybernetics.

A study of family therapy, rated outcomes as 'improvement' on a scale of 1-5, with 5 being the most improved. For a research sample where N = 10, the following data points were obtained: 3, 4, 1, 1, 4, 4, 4, 5, 5, 2.5. The mean of this sample is: A: 3 + 4 + 1 + 1 + 4 + 4 + 4 + 5 + 5 + 2.5 = 33.5 divided by 10 = 3.35 squared = 1122.5 B: 3 + 4 + 1 + 1 + 4 + 4 + 4 + 5 + 5 + 2.5 = 33.5 divided by 10 = 3.35 C: 5 X 10 = 50 divided by 5 = 10 D: 3 + 4 + 1 + 1 + 4 + 4 + 4 + 5 + 5 + 2.5 = 33.5 divided by 10 divided by 2 = 1.68

B: 3 + 4 + 1 + 1 + 4 + 4 + 4 + 5 + 5 + 2.5 = 33.5 divided by 10 = 3.35 The mean is also the average. It is calculated by adding up all of the scores on the dependent variable (each one is between 1 and 5), then dividing by the total number of scores, which is the same as the sample size, which is what 'N' represents.

When working with couples, Satir was not interested in: A: A change in his/her way of reacting to the stimulus and feedback of others. B: A change in or removal of the presenting problem. C: a change in his/her perception of him/herself and of others, which has both cognitive and affective parts. D: a change in his/her way of manifesting thoughts and feelings.

B: A change in or removal of the presenting problem. Satir is known for emphasizing the development of the client self and never directly addressing the presenting problem.

Mary, age 27, had sought therapy for unremitting problems with binge eating and laxative abuse for the past 6 years. Her therapist, trained from a Symbolic-Experiential model, saw her alone for 2 sessions at her insistence and clarified that no changes were likely without the inclusion of her husband. Mary indicated marital discord and indicated she might soon end the marriage, but that she and her husband were willing to engage in marital therapy. During the first session, the husband was unwilling to acknowledge any concern for his wife's symotoms or marital dissatisfaction. The husband's unwillingness to acknowledge these concerns were seen by the therapist as: A: resistance B: a struggle for the initiative C: an example of the 'craziness' in this system. D: an induction into the system.

B: A struggle for the initiative Struggle for initiative occurs after the therapist has won the battle for structure. Whitaker emphasizes the importance of allowing the family the freedom to determine the course of therapy. While Whitaker is concerned and active, he is respectful of the family's right to choose its own destiny, both in the therapy room and in its life outside (Piercy and Sprenkle, p. 55).

A family therapist working with a family around the acting-out 8 year-old boy goes to great lengths to inform the family that he does not have a particular answer for them as to how they should proceed. This 'not knowing' stance reminiscent of Goolishian and Anderson is used to help their clients: A: become less compliant in therapy B: acknowledge their own expertise on their own lives. C: become more focused on their family structures. D: become less invested in power struggles in therapy.

B: Acknowledge their own expertise on their own lives. The not knowing stance of a Collaborative Language therapist is designed to emphasize the non-expert stance of the therapist whose role is as a co-investigator rather than an expert. This leveling of the playing field allows the client systems competence to emerge and lead the direction in collaboration with the therapist.

The goal of Emotionally Focused Therapy is: A: to foster the creation of a secure bond between partners. B: All of the above. C: To expand and re-organize key emotional responses - the music of the attachment dance. D: To create a shift in partner's interactional positions and initiate new cycles of interaction.

B: All of the above. Emotionally Focused Therapy works to reorganize primary and secondary emotions through the creation of a strong attachment (trust) bond between partners. Once achieved new interactional patterns are developed based on the more secure bond.

When working with a client, an internal Family Systems therapist must be careful to avoid which of the following: A: working with an exile before the system is ready. B: All of the choices offered. 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.

B: All of the choices offered.

When working with a client, an Internal Family Systems therapist must be careful to avoid which of the following: A: Working with an exile before the system is ready. B: All the above C: therapist assumes he/she is talking to the person's Self and really is talking to a part. D: Therapist thinks Self is doing the work, but it's really a part.

B: All the above

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 compare types of family therapist have found the following type of therapy to be most successful: A: Psycho dynamic-eclectic family approach B: Behavioral-communication approach. C: Strategic approach. D: Structural approach.

B: Behavioral-communication approach A combination of a Behavioral-Communication oriented treatment has been found most successful in outcome studies.

A family therapist is working with a family with a large extended family. Boundaries have been very diffuse between the family and some of the younger cousins. The therapist tells a story about her own family, specifically noting a time during adolescence when a cousin dropped by unannounced and how it threw the family into a small crisis. This therapist is most likely working from: A: Structural B: Collaborative C: Narrative D: Network

B: Collaborative This therapist is operating from the stance of the Collaborative model where the therapist is much more comfortable offering a degree of transparency. A real life experience highlighting a similar experience she has had in her life is told in order to support the client system. Also important in this question is to note the stance of the therapist; s/he is a co-explorer and offers a perspective, not an answer or solution. Also note the trick use of the word diffuse to lead you astray and move you closer to the Structural model.

A family therapist is working with a family with a large extended family. Boundaries have been very diffuse between the family and some of the younger cousins. The therapist tells a story about her own family, specifically noting a time during adolescence when a cousin dropped by unannounced and how it threw the family into a small crisis. This therapist is most likely working from: A: Narrative B: Collaborative C: Structural D: Network

B: Collaborative The therapist is operating from the stance of the Collaborative model where the therapist is much more comfortable offering a degree of transparency. A real-like experience highlighting a similar experience she has had in her life is told in order to support the client system. Also important in this question is to note the stance of the therapist; s/he is a co-explorer and offers a perspective, not an answer or solution. Also, note the trick use of the word diffuse to lead you astray and move you closer to the Structural model.

'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: A: Milan systemic B: Collaborative therapist C: Structural therapist D: Behavioral therapist

B: Collaborative therapist 'Not knowing' refers to the Collaborative therapist's position, attitude, and belief, that the therapist does not have access to privileged information and that people can never fully understand each other. From this perspective, the therapist always needs to be in the state of 'being informed' by the client and needs to learn more about what has been said and not yet said.

Whose clinical model uses the following terms: placater, blamer, avoider? A: Communication - Watzlawick B: Communication - Satir C: Communication - White D: Communication - Haley

B: Communication - Satir Although Satir, Watzlawick and Haley are all associated with communication theory, Satir is the one who uses the terms placater, blamer, avoider (also leveler, and computer). White is not associated with communication theory, he is associated with Narrative approach.

Internal Family Systems believes all the follow EXCEPT: A: There are no 'bad' parts and the goal of therapy is not to eliminate parts but instead to help them find their non-extreme roles. B: Communication theory can be applied to the internal system and with the ultimate goal of a 'parts party' as a means of integrating the four parts. C: Changes in the internal system will affect changes in the external system and vice versa. D: Systems theory can be applied to the internal system.

B: Communication theory can be applied to the internal system and with the ultimate goal of a 'parts party' as means of integrating the four parts. IFS does not utilize Communication Theory or Virginia Satir's notion of the 'parts party'.

A therapist working with a family, hypothesizes that a scapegoated child's behavior may be his/her means of loyally acting out his/her parents' need for expressing anger (a cycle that may have connections to behavioral sequences begun generations before). The therapist is most likely assessing from the: A: A object-relations model B: contextual model C: Bowenian model D: Milan Systemic model

B: Contextual model Nagy has emphasized the importance of transgenerational entitlements and indebtedness in the formation of symptoms within the family. According to Nagy, invisible, often unconscious loyalties of bones across generations greatly influence present behavior. Such loyalties arise from basic human concern for fairness and result in unconscious 'ledgers' of what has been given and what is owed. One accumulates merit by the extent to which he/she 'balances the ledger'; Piercy

In which one of the following models would the therapist explore legacies, invisible loyalties, and ledge balances and thus guide family members toward those tasks necessary to restore some balance in the ledge? A: Constructivists. B: Contextual. C: Object-relations D: Transgenerational.

B: Contextual. Nagy's Contextual approach is a transgenerational model that looks at how fairness and balance are maintained by the family.

Multiethinic and multiracial families often present with rich and complex histories and dynamics. The best assessment tool for outlining the complexities of a multiracial family is a: A: Timber lawn Racial Dichotomy Scales. A genogram is useful for increasing understanding of family relationships and dynamics. Further identifying and exploring the multiracial heritages across the family generations can provide insight into isolation, bonds, beliefs, roles, and societal micro aggression. B: cultural genogram C: FACES III: Diversity Matrix D: DSM-5's GARF Ethnicity Relational Scales

B: Cultural genogram A genogram is useful for increasing understanding of family relationships and dynamics. Further identifying and exploring the multiracial heritages across the family generations can provide insight into isolation, bonds, beliefs, roles and societal micro aggressions.

Which model of family therapy has demonstrated successful treatment outcomes for depression, intimacy, and trust-related issue? A: Contextual Family Therapy B: Emotionally Focused Therapy C: Conjoint Couples Therapy D: Object Relations Therapy

B: Emotionally Focused Therapy Emotionally Focused Therapy (EFT) appears to positively impact depression, intimacy, and trust. In a comparative study (Johnson & Greenberg, 2985) EFT performed significantly better than controls and a behavioral skill training intervention. EFT couples improved problem-solving skills even though this was not the focus of therapy.

'Normal families have an evolutionary sense of time with an emphasis on the process of becoming'. This statement regarding normal family functioning is descriptive of which model of family therapy? A: Psychodynamic B: Experiential C: Structural D: Strategic

B: Experiential This is a comment by Carl Whitaker on the concept of normality within the Experiential model.

Co-therapist serves a variety of functions in family systems therapy as does the use of teams. Use of co-therapy is an important component of which of the following MFT models? A: Experiential, Contextual B: Experiential, Milan Systemic C: Milan Systemic, Structural D: Narrative, Feminist and Internal

B: Experiential, Milan Systemic Co-therapy is used by Whitaker and the Milan Group. Whitaker uses the co-therapist to provide a holding tank for him as he goes off into his own symbolic expression, while the Milan Group uses the co-therapists to adjust from gender neutrality.

This approach represents a multidimensional, theoretical model for the understanding of relationships in which men are violent toward women and argues that abusive relationships exemplify, in extremes, the stereotypical gender arrangements that structure intimacy between men and women generally, and proposes that paradoxical gender injunctions create insoluble relationship dilemmas that can explode in violence. This multifaceted approach to treatment, which incorporates feminist and systemic ideas and techniques was designed by: A: Hare-Mustin B: Goldner, Penn, Sheinberg, & Walker C: deShazer & Berg D: Madanes

B: Goldner, Penn, Sheinberg, & Walker As part of the Ackerman Institute and more specfically as members of the Women's Project, Goldner et al wrote an article entitled 'Love & Violence: Gender Paradozes in Volatile Attachments.' This question speaks to some of their findings.

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 martial problem early on in therapy is: A: de Shazer. B: Haley. C: Bowen. D: Insoo Kim Berg.

B: Haley Bowen always focused on the couple, while de Shazer and Insoo Kim Berg focused on the client's goal as part of their Solution Focused model.

In an Alderian parenting class that you are facilitating, a parent expresses concerns about his 7 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: A: He acknowledges overtly her hurt feelings to demonstrate that he understands her position about not wanting to set the table. B: He refrains from fighting but maintain his position by offering her limited choices such as how and when to set the table. C: He tells her that he loves her and that it is time to set the table. D: He helps her break the task of setting the table into smaller tasks and demonstrates how to set the table.

B: He refrains from fighting but maintain his position by offering her limited choices such as how and when to set the table. Dreikur's concept of mistaken goals utilizes several factors including a description of the child's behavior, a parent's feeling about the behavioral, a parent's typical reaction, and the child's subsequent response to hypothesis 'the belief behind the child's behavior' and suggest alternate responses. The information that the daughter is arguing and not following directive, that the father feels challenged and threatened, and that he responds by fighting which often intensifies the dynamic all point to the Mistake Goal of misguided power. With this mistaken goal, a child's underlying belief is that I only belong or count when I am in control and have power. Therefore an encouraging response from the parent can be to give a degree of power, such as limited choices.

A couple comes in for therapy. The husband complains his wife is too close to her family and she has trouble separating from them. In fact, he states that his wife is in constant contact with her mother and looks to her mother constantly to help her make decisions. Often these decisions are in opposition to decisions made previously by him and his wife. In the first session Haley would: A: track a disabling pattern B: help the couple to define the problem to be resolved. C: help the couple understand each other's perception of the problem. D: establish a hierarchy

B: Help the couple to define the problem to be resolved. Although answers helping define the problem, tracking disabling patterns, and establishing a hierarchy are all techniques used by Strategic therapists, helping to define the problem is the correct answer. The keywords in the question being 'the first session'. Haley conducts a structured initial interview which involves four stages 1) social stage, 2) problem stage, 3) interaction stage, 4) goal-setting stage. Helping the couple understand each other's perception of the problem is a technique used by social constructivists.

Family therapy with young children diagnosed with bipolar 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: A: 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, was the null hypothesis present? B: 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? C: 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, was the mean at least half the mode? D: 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, was it a qualitative study?

B: 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? The statement that control groups were used, tells us it is a quantitative study. The null hypothesis question is not correct. It is always a part of the research design. The null hypothesis says that there will be no finding of relationship between the independent and the dependent variables.

Which school of thought has recently emerged placing a renewed emphasis on language and meaning, rather than strict adherence to the more common theories of family therapy? This school of thought is more pluralistic, crossing disciplinary boundaries while breaking free of old paradigms. It views the therapist as part of the therapy process, rather than as an expert. A: Feminist B: Postmodernism C: NLP D: Constrcutivism

B: Postmodern Postmodernism emphasizes language and meaning, placing the therapist inside the therapeutic focal unit. re Study Guide, p 13.

According to research alcohol abuse is the most studied phenomenon in family therapy research. According to some outcome studies which of the following approaches have been particularly useful in dealing with substance abuse in families, especially for engaging young substance abusers? A: Strategic approach B: Psycho-educational approach C: Behavioral approach D: Structural approach

B: Psychoeducational approach Psycho-educational has proven to be the most effective in engaging adolescent substance abusers as it is non-confrontational.

Randomized clinical trials of an eclectic family approach when working with adolescents with eating disorders has demonstrated: A: Vastly higher recovery rates when working with the adolescents individually. B: Reduced hospital recividism and improved compliance with medication when psychoeducation is consistently applied to families with a member diagnosed with any variety of schizophrenia. C: Improved recovery rates when including close friends in family treatment. D: Identical recovery rates as when combining medication with community and family-based interventions.

B: Reduced hospital recividism and improved compliance with medication when psychoeducation is consistently applied to families with a member diagnosed with any variety of schizophrenia. This finding has not been reported in the MFT research literature.

Beth and Paul come to counseling because Beth feels after 2 years of marriage she and Paul have nothing in common. She complains that for the past 6 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 turns to Paul and states, 'You care enough to take the back seat and give the spotlight to Beth.' This therapist is utilizing a technique known as: A: therapeutic paradox B: reframing C: positive connotation D: circular questioning

B: Reframing Reframing is a strategic technique in which the use of a new language gives new meaning to a situation. The alteration of the meaning invites the possibility of change. The other answers can be eliminated as follows: Circular questioning is a Milan Systemic technique introduced by Salvini-Palazzoli and her associates. Circular questions are interview questions, often in the form of comparing and contrasting family member's behavior. They are used to learn more about the changes and differences in family relationships. Circular questions are useful in generating systemic hypotheses and interventions, and in allowing family members to begin viewing themselves systemically, in relation to one another. A therapeutic paradox is a more general term describing a variety of strategic interventions that involve maneuvers that appear to be in contradiction to the foals of therapy, yet are actually designed to achieve these goals (Haley, 1987). Tyles of therapeutic paradox include 1) prescribing the symptom, 2) restraining change, and 3)positioning (in which the therapist accepts and exaggerates the client's position on an issue). Positive connotation is a Milan Systemic technique in which the symptomatic behavior is reframed as being necessary and helpful to protect the family system's rigid rules. It is a formally presented intervention that includes all family members and references the family system as a whole. In contrast, a 'positive reframe', as is used in many strategic interventions, is a less formal reframing of one individual's behavior.

A 12-year-old boy was brought to therapy because he wet the bed almost every night. The mother had been hospitalized at one time for depression. The father worked long house, and the mother complained about his lack of interest in her and his attraction to other women. The expression of the father's improper behavior and an attempt to help the parents by eliciting their concern and distracting them from their other problems. This assessment of the problem is associated with: A: Structural B: Strategic C: Solution-Focused D: Object-relations

B: Strategic In Protection, Paradox, and Pretending, Madanes proposed that psychopathology in children can be the result of an incongruity in the hierarchical organization of the family. The parents are in superior position to the child by the fact of being parents, and yet the problem child assumes a superior position to the parents by protecting them through symptomatic behavior that often metaphorically expresses the parents' difficulties.

Studies have found that 76% of builmics were at least much improved using the following approach: A: Solution-Focused approach B: Structural/Strategic approach C: Object Relations approach D: Milan Systemic approach

B: Structural/Strategic approach Schwartz, Barrett, and Saba (1985) reported on treatment of builmic patients and their families using a structural-strategic model. They followed the treatment of thirty consectutive referrals and found 76% were at least much improved.

The Johnson family first presents as with the middle child, an 8-year-old boy, school refusing. Neither of his older or younger siblings is presenting with any apparent difficulties. It quickly becomes apparent that the couple is not living together and is in the process of a difficult divorce. The couple asks you about the long term effects of divorce, to which you respond: A: Once your divorce is concluded, these symptoms will disappear. B: Studies have shown divorce is a predictor of many future difficulties for children including early mortality. C: It has been shown in studies that when a divorce is traumatic, children will often exhibit symptoms such as school refusal. D: Studies have shown that divorce not an accurate predictor of difficulties in the future for children.

B: Studies have shown divorce is a predictor of many future difficulties for children including early mortality. The Longevity Project Drs. Howard S. Friedman and Leslie R. Martin http://www.howardsfriedman.com The Impact of Divorce on Children: 1) Children from divorced families died almost 5 years earlier than those from intact families. 2) Facing parental divorce during childhood was the single strongest social predictor of early death, many years into the future. 3) Having one's parents divorce during childhood was a much stronger predictor of mortality risk than was parental death. 4) The experience of parental divorce was strongly linked to earlier mortality from all causes, including accidents, cancers, and cardiovascular disease. 5) For boys whose parents divorce, the risk of dying from accidents and violence was particularly robust, as they grew up to be more reckless. 6) Children's standards of living decreased, on average, when their parents divorced, but the psychological effects went beyond the economic changes. 7) Girls and boys from divorced homes tended to end their education earlier than those from intact families, with the expected problems that then ensued. 8) Boys and girls from divorced homes were more likely to smoke and drink when they got older, as compared to their peers from intact families. 9) Girls from divorced families were than 100% more likely to become heavy smokers. 10) Those who had lived through their parents' divorce when they were children were more likely to have their own marriages end in divorce, thus perpetuating the vicious cycle. 11) A positive family environment - having positive feelings about one's family - did not ameliorate the detrimental effects of divorce. Boys with positive family feelings lived shorter lives, as it was especially traumatic to have a seemingly positive, functional home was torn apart. 12) Men who divorced were at a much high mortality risk than those who remained married. Even remarried men didn't live as long as those who stayed steadily married. This unique life-span study drastically extended and confirmed similar (but shorter-term and less intensive) feelings in this area by researchers such as Drs. Rena Repetti, Paul Amato, Judith Wallerstein, Andrew Cherlin, Jennifer Lansford, Robert Anda, and others. See Howard S. Friedman & Leslie R. Martin (2011). The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study. NY: Hudson Street Press. Information being distributed by Coalition for Divorce Reform 2011 HTTP://www.divorcereform.info/

A solution-focused therapist using the miracle question would start out in which of the following ways? A: Suppose a miracle happened and you had the power to change this situation. How would you change it? B: Suppose one night you were asleep, a miracle happened and your problem was solved. How would you know? C: Suppose one night you solved your problem. What would you be doing in a more powerful way? D: All of these could be modified miracle questions: It is used to activate a problem-solving mindset by giving people a version of their goal.

B: Suppose one night you were asleep, a miracle happened and your problem was solved. How would you know? This is the standard language and form of the Solution-Focused Model's miracle question.

The Adlerian concept that behavior has a purpose and that an Adlerian therapist should look to the purpose behind the behavior is: A: Private Logic. B: Teleology. C: Phenomenology. D: Natural Consequences.

B: Teleology. Rationale: Teleology is the concept that behavior has purpose and is movement toward some goal. In Adlerian theory it is important to understand purpose behind behavior. Adlerian therapists often work to understand how presenting behaviors relate to belonging and significance? Phenomenology is about the personal, subjective meaning a client holds. Private Logic is a personal pattern of beliefs, feelings, thoughts, and behaviors about how one strives for belonging and significance in their life.

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: A: The Structural Model B: The Solution-Focused model C: The Contextual model D: the Strategic model

B: The Solution-Focused model Finding the exception to times when the problem occurs is a Solution-focused technique.

In comparing Transgenerational with Experiential models, the one concept that both models have in common is: A: the belief that the scapegoat provides anxiety relief for the family. B: the attention to the impact of past generations on the present. C: an emphasis on differentiation of self. D: the belief that the trustworthiness of relationship breakdown

B: The attention to the impact of past generations on the present. Whitaker is known for his inclusion of both whole families and multiple generations of families in the therapy session, inferring that 'marriage is not really a combination of two-person, rather it is the product of two families, who send out a scapegoat to reproduce themselves' (Piercy & Sprenkle, 2nd edition, p. 83). The Transgenerational (Bowen) model is firmly focused on the influence of past generations as well. This is the strongest similarity in the list of answers. Other answers can be eliminated as follows: The belief that the trustworthiness of relationship breakdown because caring and accountability are absent - Contextual; An emphasis on differentiation of self -Bowenian but not Experiential; The belief that the scapegoat provides anxiety relief for the family - Experiential, but not Transgenerational.

A parent in your Adlerian parenting class reports that her son earned a B in his math class which the semester earlier he had a C. Utilizing the Adlerian concept of encouragement, members of the class brainstorm ways the mother might respond to her son. Which of the following suggestions do not fall under the concept of encouragement: A: The parent exploring what the son has learned in the process and helping apply them to future improvements. B: The parent telling the child how proud she is of his grade. C: The parent focusing on the son's internal sense of accomplishment. D: The parent reflecting on how much hard work the son invested into improving his grade.

B: The parent telling the child how proud she is of his grade. Rationale: From the Adlerian perspective, the tool of encourage is a process that stimulates growth in individuals to have confidence that they have the capacity to successfully cope with life circumstances. Characteristics of encouragement is encouragement is focuses on effort over outcome, intrinsic motivation over extrinsic motivation, successes over mistakes, and what is learned over what is not learned. Encouragement is much different that praise which focuses on approval and a positive evaluation of an outcome. While a, c, and d are all responses that fall under the criteria of encouragement, b focuses on the mother sharing her own perspective and is an example of praise not encouragement.

In Alderian parenting models, it is important for parents to pay attention to and monitor their own emotional reactions because: A: They can avoid disciplining when they are emotionally triggered. B: They can use their emotional reaction to better understand their children's mistaken goals. C: They can identify unresolved family of origin triggers. D: They can model congruent communication to their children.

B: They can use their emotional reaction to better understand their children's mistaken goals. Parents emotional reactions to their children's problematic behaviors provide clues to children's mistaken beliefs below the behaviors. Parents are taught to monitor their own emotions so the can identify the possible beliefs and identify and a connected response.

In one study, OCD patients and their families were given psycho-education sessions. The results were positive, but the sample size was small. Therefore: A: We need to know the mean and standard deviation before we can be confident of these results. B: We cannot generalize from the study to the broader population. We don't know if the positive effect will hold up when the same treatment is used in a clinical setting. C: The small sample size indicates a high significance and high confidence level. D: Thanks to the small sample size, it is easier to identify the positive effects.

B: We cannot generalize from the study to the broader population. We don't know if the positive effect will hold up when the same treatment is used in a clinical setting. This is the correct conclusion. The small sample size suggests that the finding is not necessarily representative of what you would find in the general population. Larger sample sizes provide better representations of the varieties of families and circumstances families find themselves in, in the real-world. As it stands, we would consider this study a positive sign but could not bet too heavily on it as yet. Hopefully further research would be done to validate these initial positive indications. A clinician who has themselves found positive results in applying a similar psycho-education program with an OCD patient, might have greater reason to be more confident in the study.

Which of the following therapists emphasizeed the importance of transgenerational themes: A: Satir B: Whitaker C: Minuchin D: Erikson

B: Whitaker Discussion: Whitaker, a psychiatrist, was trained psychodynamically and noted the importance of historical patterns and unfinished family business.

A family is referred to Kathy A. by the school for therapy because John, age 12, is disruptive at school and has been diagnosed as having attention deficit disorder. The mother in her phone conversation with Kathy A. say how reluctant they are to start therapy again since the previous therapist had spent most of the times 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: A: a Strategic approach B: a Psychoeducational approach C: a Behavioral approach D: an Experiential approach.

B: a Psychoeducational approach Anderson and her associates describe the psychoeducational model as a directive approach intended to prove families with 'support, information, structure and specific coping mechanisms.' The assumptions on which the model is based are: that the identified patient is a true patient by virtue of having a core biological deficit to produce overtly disturbed behaviors and cognition. Key in all Psychoeducational approaches is the empowerment of the patient family system through increased knowledge around the illness and teaching skills in dealing with the medical and other social systems.

According to research conducted by Beavers-Timberlawn, which family type is most at risk for domestic violence? A: centrifugal B: centripetal C: rigid and explosive D: cohesive and adaptable.

B: centripetal Discussion: Centripetal family members look for gratification from within the family and are less trustful of the outside world. FACES III (Family Adaptability and Cohesion Evaluation Scales) developed by David Olsen measures cohesion and adaptability. Centrifugal families tend to trust relationships outside the family more and subsequently look there for gratification. Although the rigid and explosive characteristics may be at risk for domestic violence, it is not part of the Beavers model.

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: A: tell the parents how manipulative their son is and that limits need to be set. B: discuss their son's active suicidality and encourage them to take it seriously. C: use a paradoxical intervention. D: refer the son to a psychiatrist.

B: discuss their son's active suicidality and encourage them to take it seriously. Common clinical sense is that all suicidal intent must be taken seriously. Paradox is never used in life-threatening or dangerous contexts. Knowledge domain: Family Studies & Development Practice Domain: Conducting Course of Treatment Question Type: Vignette Glossary Link Keyword: Suicidal Ideation.

A mother calls the therapist sounding very panicky, wanting an immediate appointment. At the first session, the mother states that her 12-year-old son, Sam, has just been caught in the bathroom of a neighbor's home with a 6-year-old boy. The 6-year old says that Sam was playing with his 'bum' and kissing his penis. When confronted by his mother, Sam admitted to having 'played' with the boy on 4 previous occasions. The neighbor boy's parents have banned Sam from their home and informed other parents and the school about his 'perversions'. Sam's mother called a psychiatrist prior to calling you who says stated 'You can put him into therapy and give him drugs, but it's probably already too late.' You begin seeing Sam and his family. You are also seeing another family living in the same neighborhood as Sam and his family, with a boy 2 years younger than Sam who, given this new information, you are now concerned about. In your work with Sam and his family, you should: A: innocently inquire about Sam's friends. B: explain to the family what a mandated reporter is and file a suspicion of a sexual abuse report. C: warn the other family about Sam's behavior. D: do nothing about your concern with the other boy as it would be unethical.

B: explain to the family what a mandated reporter is and file a suspicion of a sexual abuse report. You have an ethical dilemma here, with responsibilities to two families whose interests may be in conflict. The more conservative, and therefore ethically safest, approach would be to take steps to protect other children.

Mary feels threatened by the arrival of her baby sister so she pouts and becomes temperamental. When Mary acts out this way, her father thinks she is regressing and tries to get her to act her age by punishing and criticizing her. Father's harshness confirms Mary's belief that her sister is displacing her. The therapist suggests that when Mary behaves this way, the father should ignore her. If this suggestion worked, it would be a good example of: A: positive feedback B: first-order change C: second-order change D: negative feedback

B: first order change when only the behaviors or interactions when a system change, this is first order change, as opposed to second order change, where the rule governing the behavior must change.

The MRI model does not focus on: A: the continued application of the wrong solution is seen as maintaining the problem. B: functional nature of the problem. C: interctional level D: examin the sequences of behavior involved in the attempted solution.

B: functional nature of the problem. The Strategic school focuses on the funcional natura of the problem, as in thinking about what the metaphoric meaning of bedwetting might be. The MRI/Breif model focuses on the way in which the family attempted to solve the problem.

A family therapist is referred a new family whose cultural background is one that she has no experience working with. As she begins to explore the ethnicity of this family, her attention should be on all of the following except: A: national orgin B: gender roles C: cultural traditons D: language

B: gender roles This is a bit of a tricky question. Ethnicity is a broad, non-gendered term that applies to all people. It relates to a person's ethnic heritage. Hence, when exploring a famiy system ethnicity, a therapist would not address gender roles (which while important in terms of the family structure) would not be addressed from the broad idea of ethnicity. That is not to say, however, that gender roles do not have cultural influences which would include gender roles. Therefore, the best answer here is gender roles.

In assessing a couple who present with a sexual problem, a therapist would do all of the following except: A: Suggest a complete medical exam to rule out organic problems. B: get a complete family history. C: establish goals for treatment. D: conduct an extensive interview to determine the nature of the dysfunction.

B: get a complete family history. This is an exception question. The task is to find the answer reflecting what the therapist would not do. While all of the answers reflect reasonable elements of therapy, look for the best answer, not the clearly 'right' answer. The best answer will be a manner of degree, which is the least important thing to do? Sex therapists are not usually interested in a thorough transgenerational history. They are much more behaviorally-orientated and focus on the sexual dysfunction the couple presents. All of the others are clearly established elements of behaviorally-based sex therapy. Therefore, 'get a complete family history' is the best answer.

A couple comes to therapy because their three-year-old daughter is "out of control". During the session the wife begins complaining that her husband is never homes and she is left to deal with her daughter's behavior. An initial goal that a Structural Family Therapist working with this family might set is to: A: inquire about inter-generational themes. B: help the couple function together as a cohesive executive subsystem C: hypothesize as to why the daughter is so "out of control". D: look for disabling international sequences.

B: help the couple function together as a cohesive executive subsystem. Minuchin believes that the most important of all the general goals for families is the creation of an effective hierarchical structure. Inquiring about intergenerational themes is Trans-generational, look for disabling interactional sequences is Strategic, and hypothesize as to why the daughter is so "out of control" is Milan systemic.

Research has shown that a successful predictor to a positive outcome utilizing Emotionally Focused Therapy is: A: the degree to which the coupe is primarily attached to their emotional field. B: how well established the therapeutic alliance is, especially the task aspects of engagement. C: how readily a couple can give up their secondary emotional dance. D: how empathic the therapist is.

B: how well established the therapeutic alliance is, especially task aspects of engagement. Key to successful predictors of outcome when using Emotionally Focused Therapy with a couple is how well the therapist is engaged with each member of the couple system. It is from the foundation built between the Emotionally Focused Therapy therapist and the couple that a deeper emotional experience will ultimately be trusted.

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. Kathrine is apt to learn from this interaction that: A: she cannot have candy for breakfast. B: if she whines enough she gets her way. C: she can have candy for breakfast. D: attention from a parent is an extremely powerful reinforcer.

B: if she whines enough she gets her way. The candy becomes a reinforcer, ensuring that the whining will only increase when Katherine does not get her way.

A couple comes to therapy because their three-year-old daughter is 'out of control'. During the session the wife begins complaining that her husband is never home and she is left to deal with her daughter's behavior. A structural Therapist would first focus of which of the following in the first interview with the family: A: improving communication in the session. B: joining C: setting goals. D: focusing on the couple sub-system

B: joining The structural family therapist joins the family system in order to help its members change their structure.

A couple presents for treatment. The husband is of mixed Korean/Eastern European ethnicity and grew up in NYC whereas his wife, of Swedish ancestry and grew up in the Midwest. The family therapist has noticed that the husband becomes overly reactive when his wife is slightly critical of him. Interestingly, the therapist has found the husband exceptionally critical in most conversations. The therapist has noted that the husband's father, a prominent heart surgeon was often emotionally abusive when the husband was a child. This therapist is beginning to identify the: A: family projection process B: negative introject C: negative projection process D: a vicious cycle.

B: negative introject The Object Relations therapist has begun to identify the negative introject that the husband has disowned and projected onto his wife. The therapist would work to help the husband own this part of himself (his critical self) reintegrating his negative and positive introjects.

Known for his work with alcoholic systems, David Treadway suggests that a common coping mechanism for children in such systems is that adopting certain rigid roles such as: A: mover, opposer, follower, and bystander B: scapegoat, hero, and lost child C: pleaser, placater, blamer, irrelevant, and congruent D: none. Treadway has not posited any roles for children

B: scapegoat, hero, and lost child Treadway has posited that children who grow up in alcoholic systems need various survival skills in order to cope with the unpredictability of these systems. Rigid roles such as hero, scapegoat, and lost child may get children through such craziness but do so with a toll in later life. Pleaser, placater, etc., is from the work of Virginia Satir. Mover, opposer, etc., is from Kantor and Lehr. SG, Chapter 26. Key: Treadway, substance abuse, alcoholic systems, roles

One of the risks of relationship-based interventions with domestic violence, agitating the dynamics in a way that increases violent tendencies, has been addressed by recent MFT outcome research. That research: A: showed that the risk is real, and individual counseling and safety contracting is the best approach in all cases. B: showed that the risk is small when working with partners where there is reciprocal (both direction) violence and where they want to stay together. C: the literature shows few benefits to individual violence counseling, such as 'anger management. D: The literature shows significant benefits to applying anger management in addition to relationship counseling.

B: showed that the risk is small when working with partners where there is reciprocal (both direction) violence and where they want to stay together. Discussion: The risk is real, but when relationship therapy is applied to couples who want to stay together, it is minimal.

Habib is referred to a school adjustment counseling for ongoing vandalism and disrespect of authority. The referring teacher threatens to get the police involved because of the 'Jihadist overtones' of his gestures. As a family therapist, the best way to approach this situation would be to: A: get the police involved immediately. B: speak more with the referring teacher to address her concerns and explore possible resolutions before seeing Habib. C: have an initial session with Habib and his family to assess the risk of his Muslim culture becoming fundamental and therefore destructive and alert authorities if necessary. D: meet with Habib to address his anger and need to refer him to an anger management group that meets weekly at the school.

B: speak more with the referring teacher to address her concerns and explore possible resolutions before seeing Habib. Further exploring the larger context of Habib's behavior with the referring teacher and other scool officals will lend greater insight to the situation for the therapist as well as deescalate any possible over-reactions of the referring teacher. From a Systemic perspective, the therapist should consider how the referring teacher may or may not be exacerbating the situation by virtue of her own biases before seeing the student.

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 has violated his confidentiality under the HIPAA policies given to him at the beginning of his treatment. Referring to the above vignette, the client claimed that the therapist acted unprofessionally by attempting to 'explain away' his privacy concerns with a clinical interpretation. Which one of the following statements is correct? A: The client is wrong because the therapist's role is by definition to help clients understand their underlying motivations. B: the client is wrong because the therapist showed sufficient respect for the client's privacy when he gave the client a reasonable response to his privacy concerns. It's okay to add a clinical interpretation. C: The client is right if, at the beginning of treatment, the therapist had provided him with full and accurate disclosure of the limits of confidentiality. D: It is the licensing board's role to determine who is right according to industry standards.

B: the client is wrong because the therapist showed sufficient respect for the client's privacy when he gave the client a reasonable response to his privacy concerns. It's okay to add a clinical interpretation. Discussion: Every client's privacy rights are protected by HIPAA. Neither the client's diagnosis nor the therapist's interpretation of his behavior affects his privacy rights. The therapist must show respect for any privacy claim separate from clinical interpretation. However, after a clear discussion of privacy in which the therapist believes the client has understood the decisions he made, the therapist is then free to engage in a separate clinical discussion consistent with his treatment of the client, as long as he avoids undermining the client's understanding his rights. The client does not have to agree, but does have to agree, but does have to achieve an understanding of the therapist's explanation. If the client does not agree, the therapist would do well to thoroughly discuss his disagreement and then document the conversation. Central to this point is that the therapist must be sure that the clinical interpretation is in the interest of the client's ongoing treatment and is in no way intended to cover up an improper release of PHI.

The Jones family is an African American family referred to Mrs. B., a Caucasian family therapist. In working with this family, Mrs. B. should be aware of which of the following? A: The type of resistance and suspicion often manifested by African American families should not be summarily categorized as a contraindication for successful treatment. B: One of the issues that has led to the resistance of African American families toward mental health services has come from confusion about the relationship between mental health clinics and other agencies. C: All answers provided. D: For many African American families the idea of going for treatment is a very new one, and often the the questions asked by the therapist can be perceived as intrusive.

C: All answer provided. A key to understanding families of any ethnic origin is to learn how the family perceives mental health and social services agencies. The familial boundary of African-American families has developed from a kinship model which utilizes the larger family system as its support, rather than social service agencies. African-American families can often appear cautious or guarded when dealing with a social service agency seen as being part of the majority culture. It is often important to clarify exactly what is the scope your involvement with the family system and how clinical work is separate from other social service agencies.

A Haitian family therapist has just been given assigned a new case. The mandated family consists of a Dominican mother, 23, with a set of 2 yr. old twin girls. She has brought her 'aunt and uncle' to the therapy session, it appears that aunt and uncle are not released to the mother at all. Which of the following would be most helpful in both joining and assessing this family? A: There is historically tension between Dominicans and Haitians and these cultural differences between therapist and clients ethnicities may need to be addressed with the family. B: Assessing how traditional this Dominican family is. C: All of the above. D: Extended and compound households are common in the Dominican culture, and the aunt and uncle should be treated as family.

C: All the above. Historically, there have been long-standing tensions between Haitians and Dominicans since the Haitian occupation in the last century and that they share the island. Assessing whether or not this family is traditional, would help the therapist decide upon how to explore how her ethnicity might be an issue for the family. Exploring with the family how they perceive therapy, whether it means they are crazy, or see it as a waste of time would help the joining process.

You are consulting with a colleague who is working in therapy with a second-grade child who has been referred by his school counselor for bullying other children. She has been both verbally and physically aggressive towards other children. Using Dreikur's concept of Mistaken Goals you might suggest she respond to this child by: A: brainstorming ways that the client can contribute to her school community. B: Collaborating with the school teacher to set up a class meeting. C: Assessing fo and showing empathy towards the ways in which the child herself has been hurt. D: exploring the times when the client is not aggressive with other children.

C: Assessing fo and showing empathy towards the ways in which the child herself has been hurt. Rationale: This scenario addresses Driekur's mistake goal of revenge. The belief behind hurting others is 'I don't think I belong so I'll hurt others as I feel hurt. I can't be liked or loved,' (Nelson, 2006, p. 71). A proactive and encouraging response deals with the belief and hurt behind the behavior and works with the child to address their own pain. B is more of a narrative therapy exception or unique outcome. C and D are general Alderian responses but do not use the information presented to conceptualize and intervene using Dreikur's concept of Mistaken Goals.

A family comes to therapy and during the first session, the therapist observes that the 7-year old daughter sits between her parents and looks toward her mother before answering any questions. The father appears bored during the session and constantly looks up toward the ceiling whenever the daughter looks towards her mother. The 5 year old son and 9 year old daughter are sitting opposite of the parents and appear distracted and uninvolved. Which of the following family therapists would see all family members as part of the problem and reformulate symptoms into concrete observable behaviors? A: MRI B: Narrative C: Behavioral D: Structural

C: Behavioral In the Behavioral model the scientific method forms the basis for assessment. The focus is on concrete observable behavior and problems are defined in behavioral terms.

Two dimensions of family functioning measured in the Circumplex Model developed by David Olsen are: A: organization/emotional climate B: dyadic marital/executive subsystems. C: Cohesion and adaptability D: Competence and style.

C: Cohesion and adaptability Discussion: Competence and style is measured by the Beavers-Timberlawn Systems Model, Dyadic marital/exectutive subsystems is measured by Yingling's Systemic Assessment of the Family Environment (SAFE), and organizational/emotional climate is measured by GARF.

Which of the following statements are true of Emotionally Focused Therapy? A: all of the possible choices B: Emotionally Focused Therapy adds to cognitive therapy a focus on the constructive aspects of specific emotions. C: Emotionally Focused Therapy is generally contraindicated in the short term for those conditions in which there is an under-control of emotion, e.g., panic disorder and impulse disorders D: Emotionally Focused Therapy is generally contraindicated for Bulimic symptoms, including the frequency and severity of purging or vomiting.

C: Emotionally Focused Therapy is generally contraindicated in the short term for those conditions in which there is an under-control of emotion, e.g., panic disorder and impulse disorders Emotionally Focused Therapy is contraindicated for couples where there are issues related to impulse control and domestic violence. Emotionally Focused Therapy has actually been shown to reduce Bulimic symptoms, including the frequency and severity of purging or vomiting. It has also shown a reduction in the bulimic patient's drive for thinness.

In gathering information for an Alderian 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: A: Early Recollections B: Personality Priority C: Family Constellation. D: Family Atmosphere

C: Family Constellation Rationale: A Family Constellation is about a family's make up. A clinician gathers information about a client's ordinal position of the family and comparative characteristics of family members to better understand how a client finds belonging and meaning in current experiences. A Family Atmosphere is about a family's emotional tone and the climate of relationships that exist. Personality Priorities are patterned ways finding belonging and significance in times of stress. Early Recollections are memories retold as if they were happening in the presence. Alder believed that early memories held significance. In assessing Early Recollections, clinicians ask client's to retell a memory as if it was happening in the current moment and look for themes between the memory and current lived experiences.

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 John's anger at his mother and his refusal to conform to the visitation arrangements 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 for his father and mother. In assessing this family, a Behavioral family therapist would look at all of the following EXCEPT: A: self-report of family members B: rating scale of possible reinforcers C: family life cycle D: observation by the therapist of family interactions.

C: Family life cycle Discussion: Behavioral therapists focus only on the presenting problem, not on past history or underlying causes. A behavioral therapist will utilize only that which is observable as well as client self-reports and rating scales to establish what behaviors are to be changed.

A freshman female college student is attending a university and living away for the first time. She presents in therapy reporting that she is struggling to get out of bed, attend classes, and make friends. In doing an intake, a clinician learns that the student is a talented musician. She reported that she was actively involved in her high school band and held leadership roles in the organization. The clinician suggests that before the next session the student research the university's organizations and learn about three groups connected to music. In supervision, the therapist explains to their clinical supervisor that they were utilizing the following Adlerian concept to assess and intervene with the client. A: Teleology. B: Encouragement. C: Gemeinschaftsgefuhl D: Phenomenology

C: Gemeinschaftsgefuhl Rationale: Gemeinschaftsgefuhl is a foundational Adlerian term and can be observed in each person's striving to make a place for themselves. It is about both feeling a sense of belonging or membership to a group and that one's contribution to the group is valued and significant. This term is often translated into English as social interest and is considered by Adler as the measure of mental health. 'Adler viewed all problems of maladjustment as deficiencies in Social interest.....helping the person to re-direct his goals and beliefs, towards the removal of inferiority feeling and toward an increased feeling of belonging and Social Interest, is thus the aim of all Adlerian counseling, psychotherapy, and education,' (Ferfuson, 1994, p. 8). Therefore, increasing ways that this freshman client could increase belonging and significance would be essential in the therapeutic work.

Circular causality speaks to the non-linear nature of systems. This concept originates from? A: General Systems Theory. B: Cybernetics C: General Systems Theory and Cybernetics D: General Systems Theory, Cybernetics, and Choas Theory

C: General Systems Theory and Cybernetics

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: A: Hire real-world clinicians to perform the research. B: Ask clinicians to review the research and include their comments in the conclusion section of the report. C: include clients with dual morbidity in their studies D: include real-world clinicians in the design of the research

C: Include clients with dual morbidity in their studies Discussion: Most research does already have clinicians in the research design phase. Some of the strongest critiques of MFT outcome research are that research can be too dominated by clinicians who are trained in the model being tested, and therefore are biased in favor of it. Research should be objective and neutral with respect to outcomes so that we can form conclusions about it based on the most reliable findings possible.

Some research has demonstrated that there are certain common factors in successful psychotherapy. Which of the following statements is correct? A: Common factors in couple and family therapy are valuable, but not as valuable as selecting the best research supported treatment model. B: A common factor of at least .65 is necessary before we can conclude that an element of treatment is effective. C: It has been demonstrated that the common factor of 'systemic/dyadic reformulation of the presenting problem,' can be as important that ideal choice of treatment model. D: Common factors have been validated for general psychotherapy, but not for couples and family therapist as yet.

C: It has been demonstrated that the common factor of 'systemic/dyadic reformulation of the presenting problem,' can be as important that ideal choice of treatment model. The common factor components of therapy can be as important or more important to successful outcomes, than other components such as experience of the therapist or choice of treatment model.

According to a behavioral therapist, a therapeutic intervention might be designed to do all of the following EXCEPT: A: Probe for stream-of-consciousness thoughts and visual images held by each member of the couple or family system within describing past events that elicit negative affect. B: Encourages the spouses to interact during the session. C: Looking at the ways the family will resist change and the ways the family will take charge of their own growth. D: Have each member write self-report logs listing complete records of daily dysfunction: thoughts, upsetting marital/family interactions, etc.

C: Looking at the ways the family will resist change and the ways the family will take charge of their own growth. Behavioral family therapists do not concern themselves with resistance and personal growth. Change is measured via behavioral change.

A family consisting of a mother, father, two daughters ages 13 and 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 therapists asks the brother, 'Who is most upset by your sister's behavior?' Which of the following therapists would ask this question? A: Bowenian B: Structural C: Milan Systemic D: Solution-Focused

C: Milan Systemic Discussion: Milan Systemic therapists are known for their use of circular questioning. Circular questioning is a Milan Systemic technique introduced by Selvini-Palazzoli and her associates. Circular questions are interview questions, often in the form of comparing and contrasting family member's behavior. They are used to learn more about the changes and differences in family relationships. Circular questions are useful in generating systemic hypotheses and interventions, and in allowing family members to begin viewing themselves systemically, in relation to one another.

All of the following emphasize the triadic process EXCEPT: A: Haley B: Bowen C: Nagy D: Minuchin

C: Nagy Discussion: Murray Bowen introduced the concept of emotional triangles, structural family therapists have also been aware that enmeshment or disengagement between two people is always a function of reciprocal relationships with a third. Haley, Palazzoli, and Lynn Hoffman are consistently aware of triadic relationships. (Nicolas & Schwart, 4th edition, pg. 457)

A family is seeking therapy because of their child's behavior. During the first interview, the therapist asked the parents 'to what extent they thought their son was presently under the influence of the problems that had plagued his life so.' This question might be asked by a: A: Strategic therapist B: Constuctivist therapist C: Narrative therapist D: Milan Systemic therapist

C: Narrative therapist While the notion of a Constructivist therapist could be considered the correct answer, the correct response, Narrative therapist is a more accurate choice. This is an example of how a Narrative therapist, such as Michael White or David Epston, may encourage the family to see problems as entities on their own that have 'invaded' the family. This is sometimes called 'externalizing the problem'.

Drawing from John Bowlby's work, this model emphasizes the importance of healthy attachment at the infant stage of development. It also addresses the need for individuation and differentiation. A: Bowenian Family Therapy B: Emotionally Focused Therapy C: Object Relations Family Therapy D: Erickson's Developmental Model

C: Object Relations Family Therapy These are key constructs of the Object Relations model of Family therapy. Note the distractor by the use of Bowbly's Attachment Theory and the Emotionally Focused Therapy which also draws upon the Bowlby's work as well as the Object Relations use of differentiation (separating from family origin) which is different than the Bowenian use of the construct.

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 6 months and she looks sad. Mary has isolated herself from all her friends. These symptoms best describe: A: manic-depressive disorder. B: conduct disorder C: Persistent Depressive Disorder D: oppositional defiant disorder

C: Persistent Depressive Disorder Persistent Depressive Disorder is the current DSM-5 category depression or depressive neurosis was called Dysthymia in DSM-IV TR.

A family therapist has in-session goals to accentuate the client's expression of attachment needs. Such emotional expression might be termed: A: Secondary emotions. B: Catharsis. C: Primary Emotions. D: Battle for initiative.

C: Primary Emotions. This question is a good example of how a generalized notion of a family therapist actually refers to a model; in this case, Emotionally Focused Therapy. You are being tested on your knowledge that attachment needs are basis of primary emotions.

A family comes to therapy because their son has just been diagnosed as schizophrenic, The parents report that the hospital report alluded to the fact that their son's schizophrenia was caused by the family's dysfunction. The therapist states that schizophrenia is genetically based, and that the family had 'no control over it.' This therapist is MOST LIKELY coming from which model? A: Mental Research Institute B: Milan Systemic C: Psychoeducational D: Strategic

C: Psychoeducational The psychoeducational model was born in dissatisfaction with both traditional family therapy and psychiatric approaches to schizophrenia. Carl Anderson, Douglas Reiss, and Gerald Hogarty focused on the devasting impact of schizophrenia on family systems, rather than on the possible effects of preexisting family characteristics on either the onset or maintenance of the syndrome.

The Contextual model regards which of the following dimensions as the most essential and powerful in family relations? A: Facts B: individual psychology C: Relational ethics D: Family interactions.

C: Relational ethics The relational ethics dimension emphasizes the subjective balance of justice and determines relational trustworthiness, regarded as being the most essential and powerful in the family. All answers are relevant to Contextual family therapy. Relational ethics is the best answer.

Studies show that children of gay and lesbian couples compared with straight couples have: A: more problems. B: fewer problems. C: same problems. D: different problems.

C: Same problems. Although same problems might well be particular to having same sex parents, for example, having two same sex parents, prejudice toward gay and lesbians, possible lack of support from extended family, friends, etc. by in large, most of the problems will be the same found in all families. That said, such differences would be quite similar to differences found between any two family i.e. ethnicity, levels or education, class, religious beliefs, etc.

During a session a Solution-Focused therapist with a depressed client asks the client, 'On a scale of zero to ten, with 0 being how depressed you felt when you called me, and 10 being how you feel the day after the miracle, how do you feel right now?' This is a good example of a/an: A: formula task B: exception question. C: scaling question D: miracle question.

C: Scaling question Solution-Focused therapists use scaling questions to identify exceptions and to build a positive mind-set (Piercy & Sprenkle, p. 140). All answers, however, are Solution-Focused techniques. While the question refers to 'miracle' it is not an example of a miracle question.

An MFT retired to a rural area. She decided to volunteer for the local community mental health agency to do some home-based family therapy. Her work was entirely free, not receiving any compensation from the agency or from the clients. After a few months working with one particular family, the father mentioned that he often drove past her farm and noticed her barn door didn't close and was off its hinges. He stated that he would be happy to fix it for her, since she had done so much for his family. The correct statement about her obligation under HIPAA rules is: A: The same as the agency she volunteers for. B: None, since HIPAA states that 'covered entities' are defined as receiving remuneration for their services. C: She is a 'covered entity' unless she is separated from the agency as totally independent, has no access to other agency clients' PHI, and does not transmit any PHI electronically. D: Only HIPAA Security Rules apply when there is no remuneration for therapy services.

C: She is a 'covered entity' unless she is separated from the agency as totally independent, has no access to other agency clients' PHI, and does not transmit any PHI electronically. Her obligation under HIPAA would be the same as her agency's, if she were an employee, or had access to other client's PHI. If she has a private, solo practice and does not transmit any PHI electronically, she is not a covered entity. If she is providing services under her license as a mental health professional, she is still bound by the state-specific ethics and confidentiality regulations. HIPAA Security rules do not apply when the clinician is not a 'covered entity' under the Privacy Rules. HIPAA definition of a 'covered entity' does not differentiate between paid and voluntary health care providers.

The inter-generational and the Experiential therapists are concerned with all the following EXCEPT: A: inter-generational themes B: anxiety C: sibling position D: relationships

C: Sibling Position This is an exception question. Look for the answer that reflects a difference between Inter-generational (which means Bowen) and Experiential. Bowen emphasizes sibling position far more than does either Satir or Whitaker's Experiential approaches. The other answers can be eliminated as follows: Inter-generational themes and relationships are concerns of both approaches. These are similarities. For the answer 'anxiety', Bowenian therapy works to decrease anxiety, while Experiential increases it, but both are 'concerned' with it, so this is a similarity.

Which model is most closely affiliated with brief therapy: A: psychoeducational B: Milan C: Strategic D: network

C: Strategic Discussion: In 1967 the Brief Therapy Center of MRI opened under the direction of Richard Fisch. The staff included John Weakland, Paul Walzlawick, and Arthur Bodin. Their mission was to develop the briefest possible treatment for psychiatric disorders. What emerged was an active approach, focused on the presenting symptoms, and limited to 10 sessions (Nichlos and Schwarz, 4th edition)

Rituals and ordeals are specific techniques for: A: MRI therapists B: Milan Systemic therapists. C: Strategic therapists. D: Structural therapists.

C: Strategic therapists. The Strategic school, especially the work of Cloe Madanes, is known for ordeals. Students should also think of Evan Imber-Black when thinking of rituals. Jay Haley also wrote a book titled "Ordeal Therapy: Unusual Ways to Change Behavior".

Neuro-linguistic programming, founded by Bandler and Grinder, was developed through: A: MIT media lab's work with LISA, the first artificial intelligence program. B: Studying the great magicians of the world and how illusions of reality are constructed. C: Studying the work of Milton Erickson. D: Combining the work of von Bertalannfy (General Systems) and Korzybski

C: Studying the work of Milton Erickson. NLP was developed by pouring over the audiotapes, films, and writing of Milton Erickson and is based upon his particular style of hypnotic suggestion and clinical model. Erickson's work was also the foundation for Haley's Strategic Family Therapy.

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 allows for email communications with the client, keeping the emails organized and associated with the client record. The software provides a text entry area to record the session information. However, during her organical 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. As stated, the clinician in this vignette is part of a 3 person group practice. The practice is organized as a Professional Corporation. 2 of the 3 clinicians use the same practice software to bill insurance companies. The third clinician does no insurance billing and does not transfer PHI through electronic means. All of her billing is done in person with each client or on paper bills mailed out or handed to the client. However, payments are deposited into the corporate bank account, just as the other clinicians. According to the HIPAA Security Rule, the following statement is true of the clinician who does no electronic transactions: A: If this clinician does no electronic transactions covered by the Privacy Rule, then the security rule does not apply. B: If this clinician has access to the other's computers and know the passwords, and therefore can access their client's PHI, he is automatically a 'covered entity'. C: The 'covered entity' is actually the Professional Corporation since clinical work is performed by and paid for by the corporation. All 'workforce' workers must abide by the HIPAA Security Rule. D: In this case with mixed covered and uncovered entities, it is the client's option to request coverage under HIPAA.

C: The 'covered entity' is actually the Professional Corporation since clinical work is performed by and paid for by the corporation. All 'workforce' workers must abide by the HIPAA Security Rule. Under the Privacy Rule, a 'covered entity' can be an individual or a business. In this case, the professional corporation is organized and operated as the actual legal provider of services. It's true that in a PC liability runs down to each professional member, however this does not extend to excluding the corporation itself from either liability or from HIPAA covered entity status. Once the business as a whole is a covered entity, all 'workforce' clinicians are bound by the HIPAA guidelines, and all support staff must be trained to manage and protect PHI under HIPAA guidelines, and all support staff must be trained to manage and protect PHI under HIPAA rules as well. The Security Rule also applies when the Privacy Rule determines the entity is 'covered'.

An MFT has been seeing a divorced father with 2 daughters, 8 and 12 years old. After not showing up for an appointment, the MFT receives a call from the police stating that the mother reported the children and the father as missing and that he is the primary suspect in the children's disappearance. The police demand copies of his psychotherapy notes to see if there's anything in them that will help determine the childrens' location. In this situation: A: The MFT should protect his client's confidentiality and avoid involvement with the legal system. This can easily be done by informing the police that there is nothing in the notes that would indicate whether the father took the children. B: The MFT is obligated by his state's mandatory reporting law to protect the children. He therefore must inform the police about any ideas of where they might be. C: The MFT should hand over his psychotherapy notes so that the police can determine if there's anything of value to them in the notes. D: After reviewing his state's confidentiality law, the MFT determines that the state's law is 'contrary' to the HIPAA required disclosures for law enforcement, and should refuse access to his psychotherapy notes.

C: The MFT should hand over his psychotherapy notes so that the police can determine if there's anything of value to them in the notes. Discussion: HIPAA Privacy Rule states specifically that PHI and psychotherapy notes' disclosure is required for legitimate public health and safety reasons.

According to Jellinek's theory of Progressive Phases of Alcoholism, the phase associated with gross drinking behavior, blackouts, gulping and sneaking drinks is: A: the Pre-Alcoholic Phase B: the Chronic Phase C: the Prodromal Phase D: the Experimental Phase

C: The Prodromal Phase Jellinek has developed a progressive model for Alcoholism: Pre-Alcoholic Phase, Prodromal Phase, Crucial Phase, and Chronic Phase. The Prodromal Phase begins when the drinking is no longer social but becomes a means of psychological escape from tensions, problems, and inhibitions. Although the eventual problem drinker is still in reasonable control, their habits begin to fall into a definite pattern: 1: Gross Drinking Behavior: They begin to drink more heavily and more often than their friends. 'Getting wasted' becomes a habit. When drunk, they may develop a 'big shot' complex, recklessly spending money, boasting of real and imagined accomplishments, etc. 2: Blackouts: A 'blackout', temporary loss of memory, is not to be confused with 'passing out', or loss of consciousness. The drinker suffering from a blackout cannot remember things they said, things they did, places they visited while carousing the night before - or for longer periods. With prospective alcoholics, the blackouts are more frequent and develop into a pattern. 3: Gulping and Sneaking Drinks: Anxious to maintain a euphoric level, they begin to pass off drinks at parties and instead slyly gulp down extra ones when they think nobody is looking. They may also 'fortify' themselves before going to a party to ensure their euphoria. They feel guilty about this behavior and skittishly avoid talking about drinks or drinking.

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? A: The group concluded that their ethical obligations was to provide the best available treatment, as indicated by current research. Current research recommends relationship-based treatment in situations of complex domestic violence. Outcomes for individual anger management and parent counseling were not as good. B: The group recommended filing a mandated report of abuse and neglect with the sate social services department, then waiting for the report before proceeding. The local police department was informed of the situation so that they could be prepared if they were needed in the future. C: 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 an violent resistance in families that can achieve safety and want to stay together, provides best potential benefit. D: 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 separated parent counseling and anger management was established for both parents. The children were counseled to report any further instances of violence to their school guidance counselor.

C: 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 an violent resistance in families that can achieve safety and want to stay together, provides best potential benefit. Discussion: This is the best answer. It includes legal and ethical obligations, and applies treatment based upon the best available outcome research. It addresses both safety and relationship dynamics. The use of the peer group as an ongoing consultation group adds an important support and advice element for the MFT.

A male couple's therapist is working with a lesbian couple. Which of the following statements are true? A: The therapist should adjust his therapeutic stance as this is a same-sex couple. B: The therapist should question the wisdom of the couple seeing him and not a female couples' therapist. C: The therapist should approach the couple like any other couple. D: A & C.

C: The therapist should approach the couple like any other couple. Discussion: When working with same-sex couples, the work is the same as heterosexual couples. While certain issues may be different, this is true in working with any couple.

An MFT correctly remembers that HIPAA allows for keeping psychotherapy notes separate from PHI (Personal Health Information). However, the MFT also wants to document his review of relevant outcome research as part of his treatment planning. Where does the research review documentation go? A: That's the MFT's option. It can go either in the PHI or the notes file. B: AAMFT Code of Ethics (revised 2012) clearly states that research documentation is part of PHI. C: There are no definitive guidelines on where to place the research review however because it's part of treatment planning, it most logically belongs in the official file along with PHI, and should be made available for review anytime authorization to release the file occurs. D: It's clearly part of the notes because it was the MFT's option to include it.

C: There are no definitive guidelines on where to place the research review however because it's part of treatment planning, it most logically belongs in the official file along with PHI, and should be made available for review anytime authorization to release the file occurs Discussion: There currently are no definitive guidelines on where or how to document your research review. However, thinking it through, the review is part of treatment planning, which itself is not an optional element of documentation. Because the treatment planning goes in the official file, it would be most logical to put the research review there as well.

Greg argued with his parents about his curfew and his parents then grounded him. Greg then ran away and stayed with a friend. A first-order intervention at this point might be: A: to help Greg and his parents understand and rewrite the story of moving on. B: to have the parents act preoccupied and sad around Greg and imply they have given up trying to control him. C: To help the parents find a more effective punishment to tame this out-of-control child. D: to explain that this is a developmental crisis and negotiation is in order.

C: To help the parents find a more effective punishment to tame this out-of-control child. First-order change involves a change in which the fundamental rules of the system remain the same. In the above example, the rule is maintained: if you break curfew, you will have consequences. The other answers can be eliminated as follows: 'to explain that this is a developmental crisis and negotiation is in order' - the therapist is dealing with life cycle issues and tasks, thereby seeing Greg's behavior in the context of necessary changes in the family. This is a 'rule' change; arguing can have a positive purpose and should be understood and learned from, not necessarily punished. 'To help Greg and his parents understand and rewrite the story of moving on' - a Narrative approach - externalization of the problem, again changing the 'rule' from consequences to understanding and learning as a family. 'To have the parents at preoccupied and sad around Greg and imply they have given up trying to control him' - typical MRI second-order change; a change in the rules governing their response, thereby changing the meaning of a problem - maintaining interactional sequence. The hope is that this shifts Greg from feeling trapped by his parents to feeling concerned about them, and he becomes reasonable. Parents learn

Which of the following is most true regarding the treatment of premature ejaculation (P.E.)? A: Treatment will generally begin by seeing the man individually to assess his sexual history. B: Abstinence is generally the initial step in treatment. C: Treatment will involve the use of 'stop-start' or 'squeeze' technique. D: P.E. is one of the most difficult sexual dysfunctions to treat.

C: Treatment will involve the use of 'stop-start' or 'squeeze' technique. The 'squeeze' technique is commonly used to slow down or stop ejaculation. Premature ejaculation is not considered especially difficult to treat, abstinence is more likely to be prescribed in the initial phases of treating vaginismus and/or impotence, and a sexual history of the couple is often obtained early on.

All of the following are considered communication theorists EXCEPT: A: Watzlawick B: Satir C: White D: Haley

C: White White focused on meaning where communication therapists focused on behavior.

While working with a 34-year-old client, the therapist notices that a child-like voice sometimes emerges when she speaks of past trauma. Each time this happens, the client shifts into speaking about all that she must do to keep these feelings away and how this has really worked in the past. This is an example of A: a parentified child. B: a triangle C: a manager D: quid quo pro contract

C: a manager This is how the part or subpersonality of the manager works to keep the exile from feeling the pain and past trauma.

A fundamental tenant of a Constructivist perspective is that language shapes reality. In Solution-Focused Therapy this notion was: A: used to describe how language gives evidence to exceptions to the problem. B: The basis for scaling questions. C: accentuated to stating that language creates reality. D: thought to be the basis of finding exceptions.

C: accentuated that stating that language creates reality. This notion becomes the basis upon which de Shazer and Berg premise the Solution Focus Model. The therapists' use of language constructs a new reality for the client system, emphasizing exceptions to problems and strengths.

A family therapist working with a faily around the acting out 8 year old boy goes to great lenghts to inform the family that he does not have a particular answer for them as to how they should proceed. This 'not knowing' stance reminiscent of Goolishian and Anderson is used to help the cleints: A: become less compliant in therapy B: become less invested in power struggles in therapy C: acknowledge their own expertise on their own lives. D: become more focused on their family structures.

C: acknowledge their own expertise on their own lives. The not knowing stance of a Collaborative Language therapist is designed to emphasize the non-expert stance of the therapist whose role is as a co-investigator rather than an expert. This leveling of the playing field allows the client systems competence to emerge and lead the direction in collaboration with the therapist.

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 their 15-year-old daughter is coming in drunk every night and is very abusive to the family. The primary treatment goal of a structural therapist in treating this family is: A: teaching the family problem-solving B: highlighting emotional experiences C: altering the family structure D: strengthening boundaries between subsystems.

C: altering the family structure. Discussion: The keyword is primary treatment oal. Highlighting emotional experiences would be experiential, teaching the family problem-solving would be Haley-strategic, and strengthening boundaries between subsystems is a treatment goal and not the primary goal.

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: A: Be held liable for a HIPAA violation because he made a reasonable effort to handle the PHI correctly. B: be held liable for a HIPAA violation because the court requested the fax to be sent, and it was therefore the judge's and the clerk's liability. C: be held liable for a HIPAA violation because no PHI was sent. D: be held liable for a HIPAA violation if he can demonstrate that the fax number he sent to was the exact number given to him by the judge's clerk.

C: be held liable for a HIPAA violation because no PHI was sent. While identifying information was transmitted electronically, HIPAA applies only to transactions for which standards have been established. The fax was sent which contained an evaluation ordered by a court, is not a transaction for which the Secretary of HHS has established standards, and therefore the MFT is not obligated to meet HIPAA standards when conducting this transaction. The transactions that are currently covered are: claims, benefit eligibility inquires, referral authorization requests, healthcare payment information, claim status, health plan premium payments, first report of injury, and claims attachments. Note also that the court report was not created as apart of the provision of healthcare. It was part of a judicial order and is part of the legal system. The report was subject to the rules of confidentiality and privilege within that system. Therefore the identifying information (such as name, address, SS#, etc), which would be protected under a standard of HIPAA transaction are not considered PHI, that is, the identifying information was not health care information in this instance.

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: A: implosion B: coaching C: de-catastrophizing D: desensitization

C: de-catastrophizing De-catastrophizing, according to Epstein, (P. 184 FSI Study Guide, 1997), is a form of challenging extreme negative expectancies. He suggests eliciting the spouse's worst fears about specific scenarios and reality test them using logical analysis and available data. Other answers may be eliminated as follows: Desensitization - a step-wise process of exposing the client to anxiety arousing situations differs from de-catastrophizing in that desensitization is more of an action technique, while de-catastrophizing more intellectual. Coaching - de-castrophizing can be viewed as a form of coaching, but coaching is more general and includes other interventions. It is therefore not the best answer, although it is not truly wrong. Implosion is a technique to deal with affect.

Structural and MRI Strategic offer in their orientation to all of the follow EXCEPT: A: therapist use of confrontation. B: negative - and positive - feedback view of symptom dysfunction. C: emphasis on process over content. D: the punctuation of sequences.

C: emphasis on process over content. This is an 'exception' question. We are looking for the exception to differences, so, we are looking for similarities on process over content. Therefore that is the best answer. Other answers can be eliminated as follows: Feedback Loops - Structural and MRI Strategic therapies differ regarding how they conceptualize he role of feedback loops in maintaining symptoms. In Structural Family Therapy (and in Haley-Madanes Strategic Therapy) dysfunction is seen in terms of rigid, homeostatic transaction that must be broken. Drawing from General Systems Theory, a family's response that resists change (rigid transactions) is defined as 'negative feedback', as opposed to 'positive feedback' which is thought of as deviation amplifying. Therefore, an attempt to maintain the family's status quo is conceptualizing by Structural therapist as negative feedback. In contrast, MRI's version of Strategic family therapy conceptualizes family dysfunction in terms of positive feedback, or the vicious cycle created when an attempt to solve a problem inadvertently worsens the symptomatic behavior. The 'positive feedback' given to the system in an attempt to induce change, inadvertently interferes with that change. The MRI therapist's view of family problems arising from positive feedback necessitates a therapeutic focus on the behavioral sequences as the locus of analysis and the target for change. Haley-Madanes' Strategic therapy, with its assumption of a rigid, negative-loop, attempts to alter those sequences that maintain the homeostatic family structure. Structural Family Therapy attempts to alter the family's organization. Punctuation of Sequences - Sequences are punctuated differently by these two approaches. Colapinto (1991) best describes the theoretical difference between Structural and Strategic therapies through his discussion of the differences between complementary, circular causality. Circular causality designates a sequential two-way interaction represented by arrowed lines connecting A and B. Complementary on the other hand, designates a spatial configuration represented by the interlocking pieces of the puzzle. This semantic difference is not trivial, but is consistent with the Structural therapist's preference for tracking spatial arrangements among family members, rather than sequences of behavior (Piercy, et al. pp 54-55). Therapist use the Confrontation: The difference in therapeutic interventions between the two approaches are not always clear-cut but are more a matter of emphasis. For example, Structural Family Therapy is typically more confrontational than Strategic, perhaps because of Minuchin's own personal style. Although both are present-oriented. Structural Family Therapy focuses more on in-session behaviors and is more likely to employ in-session enactments. Strategic therapy, on the other hand, generally explores current out-of session behavioral sequences and employs directives to be completed outside the session to disrupt these sequences (Piercy, et al, p. 55).

Feminist family therapists are critical of the cybernetic concept of circular causality in male-female relationships because of the implication of: A: flawed family structures B: family dysfunction C: equal power and control D: none of the above; they support the concept

C: equal power and control The feminist man critique of the cybernetic concept of circular causality is that it makes everyone responsible for everything and possibly, no one accountable for anything. Neutrality position of the therapist can add further to an already unbalanced system (Goldner, 1988) by the implied acceptance of status-quo.

When a family therapist is working with people with schizophrenia, the likelihood of a positive outcome is related to the: A: patient being asked to be less critical of his/her family members which are monitored behaviorally. B: family's greater involvement on a daily basis with the ill member. C: family members exchanging their experiences and ideas in support group, while the patient complies with his/her medication. D: patient fully understanding all the concerns his/her relatives have about his/her behavior and thinking.

C: family members exchanging their experiences and ideas in support group, while the patient complies with his/her medication. When working with schizophrenics and his/her family, it is crucial that the schizophrenics take their psychotropic medications and that the family be a part of a support network with psychoeducational components.

A family therapist is working with one member of a family who reports that when she feels vulnerable, she desperately searches for ways to numb the pain. This family member seems to be describing the role of the: A: distractor B: parentified child. C: firefighter D: undifferentiated ego mass.

C: firefighter Classic Internal Family Systems defines the role of the firefighter as one who searches for means to numb or dull the pain of the exile.

A client reports, 'When I feel vulnerable, I find myself grasping for ways to dull the degree to which I feel pain. All I care about is not feeling the pain!' This client might be describing the role of the: A: parentified child. B: distractor C: firefighter D: undifferentiated ego mass

C: firefighter The Internal Family Systems model sees the nature of the mind is to be subdivided into an indeterminate number of sub-personalities or 'parts'. The firefighter is the part that attempts to numb pain through behaviors that are often addictive in nature.

A tool which Bowenian therapist use in order to reduce the anxiety level in a highly charged session would be: A: therapeutic triangle B: making I statements C: Genogram D: disabling the family projection process

C: genogram A Bowenian therapist would use a genogram in order to create a therapeutic triangle. In this instance, we are looking for a tool, not the purpose or function of the clinical tool.

In Contextual therapy the intent of multidirectional partiality is to: A: join with the family B: Establish a hierarchy C: give due consideration to each individual's interest in the various relational dimensions. D: establish circularity and neutrality.

C: give due consideration At the core of Contextual therapy (Boszormenyl-Nagy & Krasner, 1986, Between Give and Take: A CLinical GUide to Contextual Therapy) is the clinical stance that therapists are accountable to everyone whose well being is potentially affected by their interventions. This stance is known as multidirectional partiality and requires that therapists keep channels open to all family members and that all solutions serve the best interests of everyone. (Piercy, Sprenkle, & Wetchier, Family Therapy Sourcebook, Second Edition). Other answers can be eliminated as follows: Joining is primarily a Structural Family therapy technique; Establishing a hierarchy is a hallmark of Haley-Strategic; Establishing circularity and neutrality is a Milan Systemic reference, although circularity and neutrality are not truly 'established' as observed and utilized.

Some Feminist family therapists are critical of Minuchin's emphasis family hierarchies because they believe: A: it places women in conflict with their children. B: it upsets the parental subsystem. C: it reinforces gender stereotypes. D: it gives parents excessive power.

C: it reinforces gender stereotypes. Feminist Family Therapist have outlined three major mistakes mainstream family therapy theory. These mistakes are: 1) overlooks gender, one of the major building blocks of any therapy of family; 2) overlooks power as a valid construct of family systems within generations (although noted power issues cross-generationally); 3) supports the main bias in our culture, that autonomy and the differentiation of self is valued more than relational competence and affiliation. Feminist thought equally values autonomy, differentiation of self, competence, and affiliation (Hare-Mustin, 1989).

Both the Constructivist and Milan systemic therapists agree that A: externalization empowers both therapist and client to build alliances quickly, even with difficult-to-engage clients. B: the hypothesis generated about the family cannot be directly proven. C: living systems are characterized by 'loop formations' rather than linear cause-effect. D: a prescription r a positive connotation is needed at the end of the session.

C: living system are characterized by 'loop formations' rather than linear cause-effect. Both Constructivist and Milan Systemic theories share foundations in cybernetics and General Systems theory. Feedback loops and circular vs. linear causality are primary concepts from these traditions. Other answers can be eliminated as follows: 'Externalization empowers both therapist and client to build alliances quickly, even with difficult-to-engage clients' - Constructivist but not Milan technique. 'The hypothesis generated about the family cannot be directly proven' is a belief held by Milan Systemic.

Harmonious relationships are more difficult to achieve for gay and lesbian couples because: A: they are more inherently pathological than straight couples B: of shame C: our society presents them with far more obstacles D: they have more individual problems.

C: our society presents them with far more obstacles

Mr. & Mrs. Doherty presents for family therapy complaining that their son Jon will not listen to them and is acting out. Whenever they take Jon with them outside the house he creates a scene, not listening and often having a tantrum. The parents are besides themselves feeling that they have little patience and the mother states this is very similar to how she saw her parents deal with her younger brother who is now incarcerated. Specific techniques used by the Strategic therapist would include all of the following EXCEPT: A: an authoritarian approach that returns parents to the appropriate position in the hierarchy. B: ordeals which make it difficult for the symptom to be maintained. C: reinforcing of gradual behavioral changes that will ultimately lead to the goal of therapy. D: treating the child first and then attending to the couple and any relationship difficulties between the parents.

C: reinforcing of gradual behavioral changes that will ultimately lead to the goal of therapy. The correct answer is a Behavioral technique known as shaping. The other answers can be eliminated because they are examples of the Strategic model. Notice that this is an 'exception' question, which asks for the answer that is not an example of Strategic therapy.

According to the communication theorists, the content aspects of communication is known as: A: metacommunication. B: report C: request D: an analogical message

C: report All communications have a report and command elements. The report element refers to the content, while the command element refers to the relationship between the sender and receiver. Meta-communication is communication about communication. This term usually refers to the covert, nonverbal message that gives additional meaning to an overt, verbal message. Examples of an analogical or symbolic message are certain behaviors that may have a metaphoric meaning for the couple.

The Family Preservation Model seen in many federally-funded programs grew out of: A: The Structural Model B: The Milan model C: The MRI model D: The Constructivist Model

C: the MRI model The Family Preservation model, a model often required in many federally-funded programs is a strength-based model that dates back to the early years of social work, attempting to keep families intact. This model currently draws heavily from the Solution Focused Model's attention to building upon the strengths already found within the families.

Systemic couple therapy with patients suffering from depression is only indicated if: A: Cognitive therapy has been tried. B: it is given together with antidepressant treatment. C: the therapist has specialist training in systemic therapy. D: both partners are depressed.

C: the therapist has specialist training in systemic therapy. It is crucial that a couple's therapist be trained systemically when working with couples.

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: A: therapeutic double bind B: engagement C: therapist resistance D: therapeutic resistance

C: therapist resistance In a qualitative study, Kuehl, Newfield, and Joanning, 1990, described how families being treated for adolescent drug abuse experience family therapy. The researchers not that families can sometimes encounter 'therapist resistance' when therapists become more insistence in promoting their agenda for therapy despite the families' reservations.

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 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: A: realigning relationships between subsystems. B: taking sides. C: unbalancing. D: diffusing the boundaries

C: unbalancing Discussion: Unbalancing is an intervention that supports one family members and interferes with homeostasis. Unlike many other therapies that strive to maintain neutrality, structural therapists often appear to shun neutrality by taking sides.

A family therapist is trained in the Solution-Focused model. What would be their primary therapeutic goal? A: First order change. B: Second order change. C: Helping clients believe in miracles. D: A perceptual shift from talking about problems to talking about solutions.

D: A perceptual shift from talking about problems to talking about solutions. The key to the Solution Focused model is the sjift from problem-talk to solution-talk.

Which of the following statements regarding divorce are not true: A: Boys and girls from divorced homes were more likely to smoke and drink when they got older, as compared to their peers from intact families. B: Children's standards of living decreased on average when their parents divorced, but the psychological effects went beyond the economic changes. C: Girls and boys from divorced homes tended to end their education earlier than those from intact families, with the expected problems that then ensued. D: A positive family environment -- having positive feelings about one's family -- will ameliorate the detrimental effects of divorce. Boys with positive family feelings lived longer lives, as it turns out not to be especially traumatic to have a seemingly positive, functional home change its parental structure.

D: A positive family environment -- having positive feelings about one's family -- will ameliorate the detrimental effects of divorce. Boys with positive family feelings lived longer lives, as it turns out not to be especially traumatic to have a seemingly positive, functional home change its parental structure. A positive family environment -- having positive feelings about one's family -- did NOT ameliorate the detrimental effects of divorce. Boys with positive family feelings lived shorter lives, as it was especially traumatic to have a seemingly positive, functional home torn apart.

During a session with a couple a husband states to the therapist that his wife often nags and belittles him. The therapist's intervention is to give the wife homework in which she is to only say positive things to her husband and abstain from any negative comments. When she appears to be negative or belittling to her husband he is to put his hand up and say "Stop". A feminist therapist would be critical of the above technique because it: A: Gives the husband more power B: Appears to be hierarchical C: Is therapist driven D: All of the above

D: All of the above Feminists draw techniques from other schools of family therapy such as the Narrative approach, with a sensitivity to those that are especially empowering and client driven. In this case, the therapist would work together to question imbalances of power between members and the effects these imbalances have on all family members. A feminist therapist might then work with the couple to develop new stories using a collaborative approach.

Which of the following are similarities between strategic and structural models: A: they both consider the impact of the life-cycle stage. B: The treatment is symptom oriented. C: They use in-session interactions to assess the family and emphasize process over content. D: All of the above.

D: All of the above. Both models consider the impact of the life-cycle stage. They use in-session interactions to access the family and emphasize process over content. The treatments are symptom-oriented.

Which of the following statements is true? A: For boys whose parents divorce, the risk of dying from accidents and violence was particularly robust, as they grew up to be more reckless. B: The experience of parental divorce was strongly linked to earlier mortality from all causes, including accidents, cancers, and cardiovascular disease. C: Children's standards of living decreased, on average, when their parents divorced, but the psychological effects went beyond the economic changes. D: All of the above.

D: All of the above. See: The Longevity Project Drs. Howard S. Friedman and Leslie R. Martin. http://www.howardsfriedman.com/longevityproject This is an 8 decade study ended in 2011 and concluded that divorce is much more traumatic to children than the death of a parent.

The Object Relations approach to the treatment of bulimia does not suggest which of the following? A: Families are organized around specific developmental issues and the system dynamics tend to be translated intergenerationally. B: There is a bio-psychological thrust toward individuation and creative self-expression. C: The well-being of the family group is at least as important as the needs of the individual member. D: All of the choices.

D: All of the choices. This is a question that dares you to make sense of it and find a correct answer, but in reality, the answers offer nothing of value. Hence, none of the answers make any sense.

The goal of Emotionally Focused Therapy is: A: To create a shirt in partner's interactional positions and initiate new cycles of interaction. B: To expand and re-organized key emotional response-the music of the attachment dance. C: To foster the creation of a secure bond between partners. D: All of the answers provided.

D: All the answers provided. EFT strives for all of the answers cited goals.

A term that Maturana used to describe systems that can be controlled from the outside, such as machines is: A: Autopoietic B: Self-Correcting Systems C: Rubber Fence Systems D: Allopoietic Systems

D: Allopoietic Systems Originated by postmodern Chilean biologists, Maturana and Vareia, systems that can be controlled from the outside, are called allopoetic systems.

Greenberg and Johnson's emotionally focused couples therapy draws on A: Rational Emotive Therapy (RET) B: Conjoint Family Therapy C: EMDR D: Attachment theory.

D: Attachment theory Emotionally focused draws from Bowlby's Attachment Theory and the works of Carl Roger's Client Centered Counseling.

Family therapy would probably be primary intervention choice for all of the following EXCEPT: A: Problems in an individual around times of family transitions. B: Problems with children. C: Problems with relationships. D: Borderline personality issues.

D: Boarderline personality issues. Characterological disorders such as Borderline personality disorder require long-term individual treatment, hence is the best answer to this question.

Which of the following questions is intended to gather information assessing the Alderian concept of family atmosphere: A: What is your earliest memory of your mother? B: Can you tell me a little about your parent's parenting style? C: What is your sibling position? D: Who in your family was the role of peace maker?

D: Can you tell me a little about your parent's parenting style? Rationale: A Family Atmosphere i about a family's emotional tone and the climate of relationships that exist. In gathering information about family atmosphere, Alderian's often gather information about parenting styles to assess 'the extent to which it is friendly, supportive, and encouraging as opposed to authoritarian, harsh, or suppressive...' (Sweeny, 2009 pg. 13). Sibling position is connected to the Alderian concept of Family Constellation. While c and d might get at some information related to the family;s emotional tone, they might not. B, assessing for parenting style, is the response most directly connected assess family atmosphere and Alderian literature discusses assessing for parenting style when exploring family atmosphere.

Jose and Maria bring their son, Joe, to counseling because of poor academic performance and behavior. A: externalize the problem B: rearrange family members to imply alliance shifts. C: use genogram construction to help the family identify family-of-origins patterns consciously. D: coach the family on improving its problem-solving skills

D: Coach the family on improving its problem solving skills. The strategic family therapist defines the focus of treatment as the family and its interactive process, paying particular attention to the family's process of problem solving.

Jacobson's Pretreatment Assessment for Marital Therapy includes all of the following EXCEPT: A: strengths and skills of the relationship. B: Individual functioning of each spouse. C: presenting problems D: cohesion

D: Cohesion Discussion: Neil Jacobson offers an outline for pretreatment assessment. After completing the assessment, the therapist presents the couple with an analysis of their relationship in social learning terms. The assessment includes: strengths and skills of the relationship, sex and affection, future prospects, assessment of soical environment and indivudal functioning of each spouse.

An MFT is using a differentiation approach in treating an internet affair. After completing an assessment of the couple and the circumstances of the affair the therapist will A: focus on the healing and safety of the distressed spouse B: Ask both partners to define the boundaries of monogamy for their relationship. C: ask the adulterer to apologize D: confront the distressed spouse about his/her sense of betrayal.

D: Confront the distressed spouse about his/her sense of betrayal. This is not as simple a question as it may seem. The question implies working from a differentiation approach and framed this way seems a bit generic. Yet, this comes from David Schnarch's work with couples; an approach that is object relations based. Already we can see that this is not Bowen's use of the term differentiation. Here, Differentiation is the opposite of emotional fusion between the couple, though again, not as Bowen would use the concept of fusion. Emotional fusion - the protection of feelings and creating emotional safety - often drive a relationship into a stalemate where sexual needs are not met because it would cause too much anxiety to ask. An unfulfilled spouse then turns to the internet as a safe way to ask for sexual excitement. Conventionally, betrayal, in this case, is defined by the distressed partner's anxiety, insecurity, or sense of feeling threatened, but approaching an internet affair in this way will reinforce the emotional fusion of the relationship by asking both partners to continue to protect the feelings and create emotional safety. By asking the distressed spouse to define their own boundaries and begin to reflect on their own sense of functioning in the relationship, they differentiate themselves from their partner's behavior. This often results in self-confrontation, self-soothing, and becoming less reactive. Once the distressed partner disengages from the emotional fusion then the adulterer can follow suit, beginning to differentiate by owning and asking for their own needs to be met, needs that were being met by the online affair.

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: A: tell the client how you are feeling to avoid any covert issues. B: terminate therapy immediately. C: ask him out. D: Discuss the issue with a colleague in order to determine your objectivity and ability to continue working with the family.

D: Discuss the issue with a colleague in order to determine your objectivity and ability to continue working with the family. Ethical problems are usually resolved by finding the most conservative and most client-focused solution. You would therefore certainly not ask the client out, as this would violate the prohibition against dual relationships and possibly exert undue influence over your client. In some instances your clinical judgement might be that the client could handle an open conversation with you, and perhaps benefit from it, but this would not be true in all situations. Remember, we are looking for an answer that is generally accepted and safe. You wouldn't terminate therapy abruptly in any situation.

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: A: use a paradoxical intervention B: refer the son to a psychiatrist C: tell the parents how manipulative their son is and that limits need to be set D: discuss their son's active suicidality and encourage them to take it seriously.

D: Discuss their son's active suicidality and encourage them to take it seriously. Common clinical sense is that all suicidal intent must be taken seriously. Paradox is never used in life-threatening or dangerous contexts.

Family Therapist who believe that, if left alone, people will tend towards self-actualization are primarily working from the: A: Symbolic-Experiential perspective B: a place of spirituality C: Transactional Analysis perspective D: Emotionally Focused Therapy perspective

D: Emotionally Focused Therapy perspective Another question utilizing a generalized notion of a family therapist, yet hinting at the Emotionally Focused Therapy model's Rogerian influence with the phrase of 'self-actualization'.

A couple presents in crisis after the wife discovers her husband has been involved with multiple women on the internet for 5 years and has come to realize that his lack of interest in their relationship may have less to do with work-related stress and subsequent disinterest in intimacy. A family therapist believes that there is really only one way to intervene with this couple, given their current volatility. The therapist does not seem to subscribe to the concept of: A: Equipoteniatility B: Multidirectional Partiailty C: Circularity D: Equifinality

D: Equifinality A cybernetic principle, equifinality states that a similar outcome may result from many different initial events. In this instance, believing that there is only one possible way to proceed does not support the notion that there are many interventions that can achieve the same result.

Co-therapist serve a variety of functions in family systems therapy as does the use of teams. Use of co-therapy is an important component of which of the following MFT models? A: Experiential, Network and Contextual B: Narrative, Feminist and Internal Family Systems C: Milan Systemic, Solution-Focused, and Structural. D: Experiential, Milan Systemic, and Internal Family Systems

D: Experiential, Milan Systemic, and Internal Family Systems Whitaker is known for his use of co-therapist to help contain his 'craziness'. The Milan group utilized a male female co-therapy team to generate neutrality and internal family systems views the client's Self as co-therapist and trusts the wisdom of the internal system.

Murray Bowen was a pioneer in having a systemic theory for utilizing family of origin as a therapeutic resource. Another therapist who is closely associated with a treatment method of adults and their family of origin is: A: Penn. B: Whitaker. C: McGolderick. D: Framo

D: Framo. Framo is known for his work with transgenerational issues in families. His work utilization of an object relations framework emphasizes transgenerational projection of good and bad interjects.

What would you do to enhance your work with a culturally different client? A: Check out books and read about the specific culture. B: All of the above. C: Take accredited classes on a culture. D: Learn more about the culture through the client.

D: Learn more about the culture through the client. Discussion: All of the above are might be helpful, through the best answer is to learn about the culture directly from the client. A therapist may choose to read up on the ethnic ground say in Ethnicity and Family Therapy, which is a good source, but it is essential that the therapist own that s/he needs help in understanding the particulars of the cultural group from the client system.

A father has a consistent problem with the cleanliness of his daughter's room. He reports that her room is so messy that she often misplaces items that she needs for school and this often impacts the entire family's ability to leave on time for school. Encouraged to use the Adlerian parenting of natural consequences, the father might: A: Help her prepare for school the night before B: Have her wake up an hour earlier. C: Hold a family meeting to brainstorm solutions D: leave on time with other family members if she is not ready.

D: Leave on time with other family members if she is not ready. Rationale: Adlerian parenting teaches parents both natural consequences and logical consequences. Natural consequences are the results of behavior that happen without any parental intervention. Logical consequences on the other hand occur when there is some type of deliberate intervention. C and D are logical consequences. B is a natural consequence. While Adlerian parenting models encourage families to hold weekly family meetings they are not natural consequences.

The ideas that a system was more than the aggregate of its parts was pioneered by: A: Gregory Bateson B: Michael Foucault C: C.M. Marayuma D: Ludwig von Bertalanffy

D: Ludwig von Bertalanffy Bateson developed General Systems theories pioneered by von Bertalanffy. There is no one named Marayuma in the family therapy literature. Humberto Maturana is a biologically-oriented family therapist who has worked in Philadelphia for many years. Foucault works with constructivist ideas.

Parentification is a term most closely associated with: A: Minuchin B: Whitaker C: Bowen D: Nagy

D: Nagy By Definition, parentification implies the subjective distortion of a relationship s if one's partner or even children were his parents.

'John, we are impressed with your selfless gifts to your family and are inclined to suggest no changes at this time. Your soiled pants give your father a reason to be involved in your family.' This message might be one given by: A: Maria Selvini Palazzoli B: Tom Anderson C: Cloe Madones D: Paul Watzlawick

D: Paul Watzlawick This is not a positive connotation (Palazzoli), as only one member of the family systems behavior is being reframed. Anderson would likely use a reflecting team, Madanes an ordeal or hierarchy-fixing intervention, hence Watzlawick from the MRI school would emphasize 2ndorder change and this reframe is an example of such.

Solution Focused therapist hold the following to be a primary therapeutic goal: A: Second order change B: Helping clients believe in miracles C: First order change D: Perceptual shift from talking about problems to talking about solutions.

D: Perceptual shift from talking about problems to talking about solutions. While Second Order changes can certainly occur in Solution Focused therapies, changing how the client system uses language, effects its ability to create reality. Hence, this is the best answer.

Mr. & Mrs. W. were worried about their youngest daughter. They described her as isolating herself from her friends, acting somewhat listless, having a significant weight gain, and not sleeping. These symptoms best describe: A: Malaise D: Dysthymia C: Schizoid Affective Disorder D: Persistent Depressive Disorder

D: Persistent Depressive Disorder The above symptoms are indicative of Persistent Depressive Disorder as described in the DSM-5.

Mary is a 15-year old who ha 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 6 months and she looks sad. Mary has isolated herself from all her friends. These symptoms best describe: A: conduct disorder. B: oppositional defiant disorder. C: manic-depressive disorder. D: Persistent Depressive Disorder

D: Persistent Depressive Disorder. Persistent Depressive Disorder is the current DSM-5 category depression or depressive neurosis which was called Dysthymia in DSM-IV TR.

Which school of thought has recently emerged placing a renewed emphasis on language and meaning, rather than a strict adherence to the more common theories of family therapy? This school of thought is more pluralistic, crossing disciplinary boundaries while breaking free of old paradigms. It views the therapist as part of the therapy process, rather than as an expert. A: Constructivism. B: Feminist C: NLP D: Postmodernism.

D: Postmodernism. Postmodernism emphasizes language and meaning, placing the therapist inside the therapeutic focal unit, ref Study Guide, p. 13.

A family comes into therapy because of the death of the father. The family also lost the paternal grandfather. During the initial interview, the therapist found out that for three generations the father had died before the age of 40. As the therapist interviewed the family he began throwing a Frisbee to the 10 and 11-year-old children. The therapist continued to do this as he spoke and asked questions of the family. This behavior is associated with a(an): A: Object relations therapist. B: Behavioral therapist. C: Bowenian therapist. D: Symbolic-Experiential therapist.

D: Symbolic-Experiential therapist. The Symbolic-Experiential approach encourages therapists to be playful and 'crazy' as a means of engaging.

A family comes to therapy and during the first session, the therapist observes that the 7-year-old daughter sits between her parents and looks toward her mother before answering any questions. The father appears bored during the session and constantly looks up towards the ceiling whenever the daughter looks toward the mother. The 5-year-old son and 9 year-old daughter are sitting opposite the parents and appear distracted and uninvolved. A primary goal of a Bowenian therapist working with this family would be: A: to align with the father against he coalition of mother and daughter. B: to effect family organizational change. C: to track the vicious cycle. D: the differentiation of family members.

D: The differentiation of family members. According to Bowen's (1978) theory, the more separate one's intellect is from automatic emotional forces, the more differentiated one is (Piercy & Sprenkle, 2nd. ed.). Other answers can be eliminated as follows: align the father - Structural; Effect family organizational change - Structural or Strategic; Track the vicious cycle - Strategic.

An MFT in private practice keeps some of her clinical records on her laptop computer, which she carries back and forth to work every day. One evening after work she stopped to meet a friend for dinner before going home. When she returned to her car she noticed the trunk was open and then found her computer had been stolen. All client-identifying information (PHI) was kept in her office in a locked file cabinets. According to the Security Rule: A: Psychotherapy notes are more sensitive than PHI and there is a higher standard for their protection. They must be kept in a stationary-location, never moved around unnecessarily and must be reasonably secured, which usually means in a locked file cabinets. B: HIPAA rules treat psychotherapy notes exactly the same as PHI. C: Because the medical record might be requested by the client at any time, psychotherapy notes and PHI must be kept in a location readily available. Keeping notes in a laptop that goes home might make them unavailable and is not acceptable. D: Psychotherapy notes that do not contain specific PHI identifiers are not covered by the Privacy and Security rules.

D: The psychotherapy notes that do not contain specific PHI identifiers are not covered by the Privacy and Security rules. HIPPA rules separate psychotherapy notes from PHI. The Privacy Rule protects both, but provides greater protection to notes. Under HIPAA, psychotherapy notes must not contain information that would identify the subject individual(s) or routine aspects of their treatment such as: times of appointments, medication, and diagnosis. If the notes do identify the individuals, they are by definition PHI, whether they contain therapy process information in addition, or not. Any Information in the clinician's possession that does not contain identifying information is not regulated by HIPAA. This would be the case if for example, you identify clients by account numbers but not full names in your notes. notes and other information in our possession can be 'de-identified' by removing all PHI.

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. Referring to the above vignette, in this situation: A: The client is correct because the Privacy Rule protects all information that can identify a specific client without regard to the client's clinical issues. B: The client is correct, but only if the therapist is a 'covered entity' of the Privacy Rule. C: The client is correct because whether the therapist is a 'covered entity' for HIPAA or not, the therapist is nevertheless obligated to abide by his state's confidentiality statutes which also protects identifying information. D: The therapist's disclosure is allowed if he can demonstrate that it falls under the guidelines of the 'Permitted Disclosures' clause of the Privacy Rule.

D: The therapist's disclosure is allowed if he can demonstrate that it falls under the guidelines of 'Permitted Disclosures' clause of the Privacy Rule. Discussion: All disclosures of PHI are not prohibited under the Privacy Rule and also not always prohibited in most state-specific confidentiality rules. Also, it is not always necessary to obtain a written authorization to release information, so long as the therapist provided a thorough and accurate disclosure of how he handles PHI at the onset of therapy. The 'Permitted Uses and Disclosures' clause of the Privacy Rule allows the therapist to use his own judgement in disclosing identifying information if it is either a normal or necessary part of 'treatment, payment or health care operations'. In this case, the therapist would have to demonstrate that there was a need to disclose the client's town of residence as part of the peer supervision discussion. Some acceptable purposes would be if the peer group used town of residence to differentiate this particular client form another (thereby avoiding even greater identification that would occur names were used), or if the peer group were assisting with insurance billing and the forms were being completed in the meeting. however, the principle of 'minimum discourse stipulates clinicians should not disclose names or residence in supervision unless there is a good reason to do so, and then the reason should be documented. If the disclosure were casual and not for a good treatment or health care operations reasons, then the disclosure is not allowed under the Privacy Rule without written authorization. If the clinician was not a 'covered entity' according to the Privacy Rule, then HIPAA guidelines would not apply, and the state-specific confidentiality statues would determine the legitimacy of the disclosure. Where conflicts occur between state specific guidelines and HIPAA rules, the HIPAA principle of 'preemption' states that the federal guidelines will override state guidelines except in certain specific circumstances, such as mandatory reporting requirements in state licensing laws.

Which stage of the Family Life Cycle is most conductive to immigrating to a new country? A: Families with school-age children stage. B: Launching Stage C: Adolescent Family Stage. D: Young Adult Stage

D: Young Adult Stage When individuals immigrate to a new country as a young adult, they have the greatest potential to adapt to the new culture in terms of career and marital choices, yet are prone to cutting off connections to their previous heritage.

Blended families present unique circumstances for a therapist. Which of the following would be helpful to a family therapist in facilitating discussion: A: offering clear rules around how each parent should parent their non-biological children. B: all of the above. C: a reflecting team utilizing each family as a team in a fishbowl dialogue. D: addressing the boundary ambiguity often found when merging families.

D: addressing the boundary ambiguity often found when merging families. Boundary ambiguity: Children have simultaneous membership in two families, which can lead to loyalty conflicts and guilt, especially when the relationship between ex-spouses is hostile. The couples need to establish clear executive subsystem boundaries, which can be complicated by differences in the rules that each spouse prefers and the movement of the stepparent from an outside position to inside the family.

A couple presents for family therapy saying that 'whenever they talk, they argue,' and that their conflict has been escalating and is getting scary. The husband Bob is 48; his wife Donna is 29. They have two teenag children from Bob's previous marraige. Bob is a project manager for a large corporation with responsibility for numerous national and international locations which frequently take him away from home. Donna is getting a graduate degree. Donna complains that neither of the teenage boys will listen to her when he is away from home. In working with this family, a therapist working form the Feminist Model of Family therapy would most likely: A: suggest that the couple look at how various household responsibilities that each are responsible for, helping the couple to creaste a more equitable distrubition. B: Ask the couple to talk to each other about the values each has towards men and women. C: maintain a neutral position, being careful not to side with either partner. D: align with the wife in the couple system.

D: align with the wife in the coule system Femenist family therapy theory espouses the importance of a therapist taking an in-session posture that imbalances the historic power imbalances between men and women, key: Feminist Family Therapy, power, therapist posture

The philosopher Foucault exposed how various discourses within a society: A: generate a mythological benchmark of perfection which they describe as Normal Development B: generate further schisms between those with and without power. C: reinforce societal influences which ultimately influence a society's perception as to what is abnormal development. D: are dehumanized, objectified, and marginalized by various social groups who are in power over the other groups.

D: are dehumanized, objectified, and marginalized by various social groups who are in power over the other groups. Foucault traces the ways in which discourse shapes perception, focusing often on those individuals and practices considered marginal or abnormal, but finding in them keys to understanding the fragile and imperfect ways that power is developed by the upper classes, the medical establishment, the scientific community, and the literacy and political elite.

A mother calls the therapist sounding very panicky, wanting an immediate appointment. At the first session, the mother states that her 12-year old Sam jas just been caught in the bathroom of a neighbor's home with a 6-year-old boy. The 6 year old says that Sam was playing with his 'bum' and kissing his penis. When confronted by his mother, Sam admitted to having 'played' with the boy on 4 previous occasions. The neighbor boy's parents have banned Sam from their home and informed other parents and the school about his 'perversion'. Sam's mother called a psychiatrist prior to calling you who she says stated 'You can put him into therapy and give him drugs, but it's probably already too late.' You begin treatment with this family by seeing Sam along with his family. Which of the following approaches would a strategic family therapist not use in working with this family? A: Take full responsibility for change. B: attempt to find out what has been tried to solve the problem before. C: use paradoxical intent. D: ask the miracle question.

D: ask the miracle question. The miracle question is associated with Solution-Focused while all other choices are clearly used from the MRI perspective.

A therapist is seeing a 7-year-old girl and she reports that when daddy kisses her he puts his tongue in her mouth. An ethical therapist would err if he: A: documented clearly what the daughter has reported in the case notes. B: reported immediately to proper authorities CL filed a written report to the proper authorties. D: contracted with the father to not kiss his daughter this way.

D: contracted with the father to not kiss his daughter this way. Almost every jurisdiction has certain mandatory reporting laws requiring therapists and other helping professionals to break confidentiality and report certain kinds of communications. Most of these laws involve potential or suspected child abuse and such laws make it clear that any therapist or other helping professional has a clear legal duty to notify an appropriate state agency if the professional has any reason to believe that there has been physical or sexual abuse of a child. Such mandatory reporting laws are covered by section 2.1 (a) of the AAMFT Code of Ethics (Brock, Ethics Casebook, pp 163-164). In contracting with the father, the therapist has no guarantee he will stop the undesirable behavior.

You have been hired to speak to a group on family therapy. You are introduced as having a Ph.D. when in fact you have a M.A. In this case, you should: A: It doesn't make a difference who corrects the mistake as long as it is correct. B: Do nothing since it wasn't your fault. C: speak to the person who introduced you and request that she correct the mistake. D: correct the mistake yourself as it is your responsibility.

D: correct the mistake yourself as it is your responsibility. The AAMFT Ethical Guidelines state that it is always the therapist's responsibility to see to it that his/her credentials and expertise are represented properly.

Dr. A trains family therapists. Mary B. is Dr. A's student. Midway through the year, it becomes evident to Dr. A that Mary could benefit from therapy. When she approaches Mary with her recommendation, Mary agrees and asks Dr. A to be her therapist. Dr. A: A: says yes, but that she will have to get supervision because Mary is her student. B: tells Mary she will be her therapist if Dr. A gets permission from the director. C: decides to be Mary's therapist, since she already knows many of the issues. D: declines on the grounds that it would be unethical.

D: declines on the grounds that it would be unethical. 4.1 (AAMFT Code of Ethics)

The Narrative model uses the term 'External Invaders' to describe: A: the isomorphic nature of ecosystemic influences that disrupt the unique outcome. B: a psychotic person hearing voices. C: an externalized loci of control. D: destructive internalized emotional states and beliefs.

D: destructive internalized emotional states and beliefs. 'External Invaders' is used to describe how a feelings and beliefs can become fused with a person; thus it's often very difficult to discriminate them from the person themselves.

When doing therapy with an Italian family, the therapist must be aware that Italian families are concerned about: A: "making a scene" B: dependency and emotionality. C: their children not being successful. D: Disloyalty to the family.

D: disloyalty to the family. According to McGoldrick's research in the different ethnic groups ideas vary about what is problematic: WASP families may be concerned about dependency or emotionality, Irish families about 'making a scene', Greek families about any insult to their pride, Jewish families about their children not being 'successful', and Puerto Rican families about their children showing respect.

A young woman was hospitalized with a diagnosis of schizophrenia. During one of the family therapy sessions, the daughter walked into the room and went toward her father to greet him. The father stiffened, the young woman withdrew and the father said, 'I thought that you'd be happy to see me?' A family therapist would consider this interaction an example of a(n): A: quid pro quo contract B: isomorphism C: the positive feedback loop. D: double bind

D: double bind Discussion: In 1956: Bateson and his colleagues published their famous report, 'Toward a Theory of Schizophrenia,' in which they introduced the concept of the double bind. They assumed that psychotic behavior might make sense in the context of pathological family communication. Patients weren't crazy in some autonomous way, rather their behavior was an understandable extension of a crazy family environment. Consider someone in an important relationship where escape isn't feasible and a response is necessary; when he or she receives 2 related but contradictory messages on different levels, and yet finds it difficult if not impossible to detect or comment on the inconsistency, that person is in a double bind. (Nichols & Schwarz, 4th edition).

When working with families presenting with an anorexic family member, Structural family therapists believe that anorexia nervosa is a problem that results from: A: compliance B: perfectionism C: disengagement D: enmeshment

D: enmeshment Discussion: Compliance and Perfectionism are individual characteristics of an anorexic client. Minuchin's Structural Model famously focused treatment through his linch sessions with the anorexic family member and with the whole family. The goal of the Structural Model is to increase the level of functioning in which the members were more highly differentiated with more autonomy, freedom, responsibility, and spontaneity. According to Minuchin, by addressing the family system's enmeshment the family becomes was more flexible, with less rigidity of roles and more adaptive patterns of communication and problem-solving. As a result of changes in family structure and functioning, conflicts could be resolved and the need for detouring conflicts was eliminated. Hence, the best answer here is enmeshment as it speaks to the family's assessment, not the individual characteristics of the anorexic family member. See: The Role of the Family in the Treatment of Anorexia Nervosa Ronald Liebman, M.D., Salvador Minchin, M.D., and Lester Baker, M.D.

Mr. & Mrs. Doherty present for family therapy complaining that their son Jon will not listen to them and is acting out. In designing a treatment plan, a Contextual family therapist would: A: map the system. B: track disabling sequences. C: assess the credits and debits. D: establishing long and short term goals.

D: establishing long and short term goals. The Contextual model does focus on goals, both long and short term. The overall goal of this therapy is to address injustices and distrust which are the causes of dysfunction (Boszormenyi-Nagy & Ulrich, 1981, "Contextual Family Therapy", in Gurman & Kniskern's, "Handbook of Family Therapy"). The other answers can be eliminated as follows: 'track disabling sequences' - Strategic; 'assess the credits and debits' - Contextual, but an aspect of assessment, not part of treatment planning; 'map the system' - Structural.

When a Solution-Focused therapust, working with a client presenting with issues around alcohol abuse, asls 'What needs to be different with your drinking?', they are begining to negotiate the: A: first-formula session task B: solution talk of the therapy C: miracle question D: exception to the problem

D: exceptions to the problem. Solution-Focused therapists use questions that often center around making distinctions. Here the therapist is beginning to look for when the drinking is or is not a problem and to tease out what is working in the client's life.

During the process of treatment, Mr. Medieros recognizes how he was victimized by his parents, and that past generations were also victimized by their parents. In recognizing this he began to see his parents less as monsters and more as struggling human beings, themselves acting out invisible loyalties. Therefore, he was able to block the trans-generational pattern of destructive entitlement and allowed the positive transmission of relational resources. The process by which he earned entitlement by dealing with his own issues with his own parents is called: A: A family projection process B: relational ethics C: societal regression D: exoneration

D: exoneration Exoneration is a process by which the therapist attempts to help the client see the positive intent and inter-generational loyalty issues that motivate the behavior of members of previous generations.

A family therapist who emphasizes the importance of the psyche and the significance of sub-personalities believes the role of the Self should be to: A: develop a more internalized loci of control. B: create a balance between the Exile, Manger, and Firefighter such that all parts will exist and lend talents that reflect their non-extreme intention. C: integrate the good and bad introjects D: generate a degree of trust so parts will provide input to the Self, but will respect the leadership and ultimate decision-making of the Self.

D: generate a degree of trust so parts will provide input to the Self, but will respect the leadership and ultimate decision-making of the Self. Internal Family Systems therapist sees trust as being essential for the Self to gain credibility among the other sub-personalities in the quest towards becoming a self-led person.

According to Schwartz, the role of the Self should be to A: integrate the good and bad introjects. B: develop a more internalized loci of control. C: create a balance between Exile, Manger and Firefighter such that all parts will exist and lend talents that reflect their non-extreme intention. D: generate a degree of trust so the parts will provide input to the Self, but will respect the leadership and ultimate decision making of Self.

D: generate a degree of trust so the parts will provide input to the Self, but will respect the leadership and ultimate decision making of Self. This is the goal of IFS therapy, to have all the parts of self trust the Self to such a degree that they support the Self's ability to make informed decisions taking into account the various parts concerns.

Sensate focus, a frequently used task in sexual therapy, is used to: A: as a paradoxical approach B: increase sexual awareness. C: Increase awareness of physical sensations. D: reduce performance anxiety

D: reduce performance anxiety Sensate focus is a procedure originally developed by Masters and Johnson to create an atmosphere whereby performance anxiety and spectatoring can be minimized.

Mr. & Mrs. A report that the school has called and informed them that their fifth-grader has been disruptive and inattentive in class. The teacher has called on a number of occasions saying they could not control the son's behavior. The parents had a meeting with the school and the school staff suggested family therapy. In questioning the parents, the therapist found out that the child has had difficulty in school from the first grade, but is not a behavioral problem at home. The therapist should: A: introduce a behavioral contract between the home and the school. B: Refer to a psychiatrist for a medication evaluation. C: work with the couple system D: suggest the child be tested to rule out a learning disability.

D: suggest the child be tested to rule out a learning disability. The therapist is still at the assessment stage with the family. The information given by the parents that there is a history of difficulty at school but not at home suggests that the child may be having difficulty learning at school. An assessment regarding his ability to learn would be the first step in working with this family. The other answers can be eliminated as follows: Medication evaluation - the child is not a behavioral problem at home and there is no information that suggests this child has ADHD. Additional information is required prior to seeking medication evaluation.

In working with a divorced couple, the focus of the attention should be: A: the mother and oldest child. B: residential parent. C: the children D: the couple.

D: the couple Often children are neglected emotionally during this period because parents are overwhelmed by their own needs. Since there is research evidence that children's post-divorce adjustment is directly related to the parent's own adjustment, a therapist may gain leverage to encourage partners to continue working on their own emotional issues by informing them of the benefits of the children. The form of intervention most directly related to restructuring is divorce mediation.

A feminist approach to family therapy includes all except: A: an awareness of attempts to counteract the ways in which family therapy may reinforce women's subordinate position. B: a recognition of women's subordination and inferior social position. C: the idea that family therapists often have stereotypical expectations of men and women. D: the idea that family therapy attempts to empower and strengthen all family members.

D: the idea that family therapy attempts to empower and strengthen all family members. A Feminist's approach is singular for its emphasis on empowering women in particular. This is a corrective measure to counteract women's usual paradoxical position of having primary responsibility for the family while having reduced power for carrying out the responsibility.

Entropy is: A: the tendency for a system to introduce more organization. B: transactional style C: a family task D: the tendency for a system to break down into less organized states.

D: the tendency for a system to break down into less organized states. Entropy is a measure or disorganization. Your house will fall into disrepair if you maintain it. You might say it starts in a highly 'organized' state when it's new and becomes more disorganized by weathering and wear and tear. You fight this tendency by painting it, etc. The house increases in entropy when left to the influences of weather. You can decrease the house's entropy by fixing it. It is also said that you would be increasing the house's neg-entropy by fixing it.

A mother calls the therapist sounding very panicky, wanting an immediate appointment. At first session, the mother states that her 12 year old son Sam has just been caught int he bathroom of a neighbor's home with a 6 year old boy. The 6 year old says that Sam was playing with his bum and kissing his penis. When confronted by his mother, Sam admitted to having played with the boy on 4 previous occasions. The neighbor boy's parents have banned Sam from their home and informed other parents and the school about his perversions. Sam's mother called a psychiatrist prior to calling you who says stated 'You can put him into therapy and give him drugs, but it's probably too late.' You begin seeing Sam and his family. In working with this family, you are asked by the parents, 'Does this mean our son is gay?' The most likely response a family therapist might make to such a question is: A: 'Yes, it is very likely that he has made an early sexual identity choice.' B: 'Only if he continues to molest other children.' C: 'At this stage of development, it is not unusual for children to be sexually inquisitive and that this does not necessarily have any bearing on sexual identify.' D: to carefully explain that there is a high likelihood that some sort of sexual trauma may have occurred to their son.

D: to carefully explain that there is a high likelihood that some sort of sexual trauma may have occurred to their son. Most appropriate clinical response. Knowledge Domain: 5. Family Assessment Practice Domain: 1. Joining/Assessment/Diagnosis Type of Question: Vignette Glossary Link Keyword: Ethics

What is the purpose of licensure for Marriage and Family Therapist? A: to create a third party eligibility. B: to generate revenue for the states. C: to exclude other professionals from practicing MFT. D: to maintain integrity of the profession.

D: to maintain integrity of the profession. Not all states that have licensure have third party eligibility (vendership). While generating revenue, it is not the primary purpose of licensure. Licensure does impose a standard of training on those identifying themselves as MFTs, though not to exclude other discipline.

When having discovered that a client is HIV positive and has withheld this information from his spouse, the therapist's ethical responsibility is: A: inform the spouse B: to protect client confidentiality C: to decide if withholding this information the therapist is putting the wife at risk. D: to protect the client's confidentiality unless mandated by state law to do otherwise.

D: to protect the client's confidentiality unless mandated by state law to do otherwise. The laws of confidentiality are changing state by state to accommodate the problem of HIV. However, as of this writing, the national guidelines are the ones tested on the AMFTRB exam. AAMFT guidelines prohibit break of confidentiality absence of an immediate and identifiable physical danger. With HIV, there may or may not be an immediate danger. The therapist cannot know for sure. Indeed, the law in some states and court jurisdictions is developing in the direction of placing positive HIV status in the category of a legal 'duty to warn' because of its dangerousness. In these jurisdictions, failure to warn about HIV would then also violate AAMFT ethics principle 2.1 'Marriage and Family therapist may not disclose client confidences except, as mandated by law, to prevent a clear and immediate danger to a person or persons, where the therapist is a defendant in a civil, criminal, or disciplinary action arising from the therapy.....'

Common techniques used in Structural Therapy include: A: positively connoting dysfunctional interactions in sessions B: teaching families how to tell their own Structural narratives C: asking circular and reflexive questions prior to an enactment. D: unbalancing the family equilibrium and re-aligning boundaries.

D: unbalancing the family equilibrium and re-aligning boundaries Structural Family Therapists emphasize the need to break the family's homeostasis and use unbalancing techniques in order to do so. Once the equilibrium is broken, the Structural therapist re-organizes the family into a healthy structure.

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: A: applies just as it would to any other office setting. B: does not apply because of the home-office exception. C: would indicate a violation occurred, if standardized transactions were transmitted electronically. D: would indicate that no violation occurred because passing by residents of the MFT's home is considered part of a permitted disclosure.

D: would indicate that no violation occurred because passing by residents of the MFT's home is considered part of a permitted disclosure. As long as the clients were aware that the MFTs office was in her home, it is then reasonable to assume that they were aware that they might encounter other family members. When clinicians work in traditional professional office space, clients generally realize that they will encounter other clients and clinicians in the waiting room. It is a normal part of healthcare operations for clients to encounter other people as they attend their therapy sessions. If the clinican misled the cleints about the presence of others, or if the client requested special privacy arrangements that the clinican agreed to be failed to provide, a violation or potentional misleading full disclosure statement might exisit. However, encountering others either in waiting rooms or passing by on the way to appointments is considered a normal part of healthcare operations, and is therefore allowed disclosure.