AATBS Sample Exam Flashcards
A woman who was just raped calls you in crisis and then comes to your office that day. She tells you that she does not want to press charges. You should first:
Suggest a doctor’s examination.
Explanation: Clearly, you as a therapist will want to help her process the emotional issues related to the rape. However, you can determine that suggesting a doctor’s examination is the best “first” intervention because the client may have physical injuries as a result of the rape, and these injuries may require immediate medical attention.
Answer A: (report the rape to the police) This would not be an appropriate response. It would violate the client’s confidentiality, and a therapist is not required to make this report.
Answer B: (maintain her confidence and deal with the issues therapeutically). Although the therapist will maintain her confidence and help her process the issues therapeutically, suggesting a doctor’s examination should occur first.
Answer D: (ask her for details about the rape) Although the therapist will help the client process the situation, asking for details about the rape may not be appropriate, especially as a “first” intervention as is asked in the question.
A woman you have been seeing is terminating therapy early because she is going away to college soon. What should you do?
Ensure she gets therapy in her new location.
Explanation: Ensuring that the client gets therapy in her new location would be the best choice of the options provided. It clearly states that the client is needing to terminate therapy early, therefore implying that treatment goals are not yet achieved. By ensuring that the client gets therapy in her new location can also include that referrals have been provided.
Answer B: (Try to do as much as possible with her before she moves.) Rushing or cramming services in a fast manner would not be appropriate for the client.
Answer C: (Do occasional phone sessions with her after she leaves for school.) Phone sessions could be appropriate to continue after she leaves for school, however, the best choice would be to help the client get set up with services at her new location.
Answer D: (Tell her to come back and see you during school breaks.) The question implies that services are still needed and termination is occurring early, therefore telling the client to come back during school breaks would not be appropriate.
The Johnson family comes to you for therapy. They have three children: Bill, age 15, Sally age 9, and Michael, age 7. Bill is rebellious and hostile at home. At school, he has been truant and fighting with teachers and peers. In the initial interview, you notice that the mother seems to dominate the family. You have to intervene several times when the family “gangs up” on Bill, as they seem to think that he is the source of all of their problems. After the second session, the mother asks you to see Bill alone, since “he is the one with the problem”. You agree to do this for a few sessions, but explain that, after this, you will want to see the whole family again. Before your third session with Bill, the mother calls and says that Bill’s behavior has not improved, and that therapy is not working. What would have been the most appropriate therapy in the above case?
Reframing Bill’s bad behavior as serving some useful purpose in the family system.
Explanation: Reframing Bill’s bad behavior as serving some useful purpose in the family system.
It seems that Bill has been identified by the family as the identified patient, or the one “with the problem.” What we know in family therapy is that the identified patient’s symptoms are often an expression of the family’s dysfunction and are being maintained in some way by the family system. Reframing, or relabeling Bill’s behavior would help the family view the issues in more positive ways.
Answer A: (Immediate problem-solving via a carefully designed behavior modification program targeting Bill’s objectionable behaviors.) This intervention would further label the client as the identified patient and encourage the family to continue seeing the problems as they previously have.
Answer B: (Referring Bill to a teen group where he would get support and some “reality therapy” from his peers.) This would further label the client as the identified patient and the family would not get the systemic therapy that is needed.
Answer D: (Confronting the family about their faulty beliefs and dysfunctional communication patterns.) This could be a possible intervention if the therapist was utilizing a strategic approach. This intervention would also be more appropriate in sessions after a therapeutic relationship was established. In this scenario, that has not yet occurred.
A mother brings in her daughter, age five, for play therapy. The daughter has been clingy and anxious. The mother tried to enroll the daughter in preschool, but the child cried all day and had to be taken home. This also happened the second time she tried to take her to preschool. The mother tells you that her daughter has” always been sensitive” but that things have been worse lately because of the tension between the mother and the child’s father, who does not live with them. The best way to diagnose the problem would be to:
directly observe interactions between the mother and daughter.
Explanation: Observing the interactions between the mother and daughter will help you to assess and diagnose the problem.
Answer B: (ask the mother what she observes in the daughter) The mother has already shared what she believes to be going on, and although this is helpful, it will be more telling to see the observations and interactions.
Answer C: (observe the child’s themes in play) While this may be a helpful intervention at some point, the best way to assess and diagnose the problem would be direct observation. Separating the child at this point could also increase anxiety.
Answer D: (ask the child what she thinks is wrong with her) This would not be an appropriate or helpful intervention with a five-year-old. This option is also stated in a negative way of what is “wrong with her” and does not align with systemic beliefs.
John and Jacob are brothers that grew up in an extremely authoritarian household. The father demanded strict obedience and harsh punishments. Once they became adults themselves, John had similar parenting styles and raised his children in the same way in which he was raised. Jacob, on the other hand, was mindful to change these patterns, and instead parented his children with a loving, teaching, and supportive style. This is an example of _________________.
equipotentiality
Explanation: Equipotentiality predicts that the same initial circumstance can have different outcomes. This can help therapists learn not to predict causality within a family, but to instead focus on patterns of interactions and the contexts in which they occur.
Answer A: Equifinality is in contrast to equipotentiality in that it predicts those different initial circumstances can have the same outcome.
Answer C: Homeostasis refers to a family’s current state of equilibrium and makes family members resistant to change.
Answer D: Morphostasis is the tendency of a system to maintain a steady-state. A balance between this and morphogenesis is necessary for maintaining a well-functioning system.
During your second session with a client, she tells you that she had a sexual relationship with her former therapist. She says that she is embarrassed and just wants to forget the whole thing, but that she still has feelings for the therapist. The client also says that she’s told you this because she trusts you, but she knows that therapists “stick together” and that you probably won’t do anything. Your ethical obligation in this situation is to ______________.
inform the client of her legal rights and options.
Explanation: The AAMFT Code of Ethics doesn’t directly address this type of situation, but this answer is most consistent with the “spirit” of the Code and with the requirement of Standard 1.7 to “respect the rights of clients to make decisions and help them to understand the consequences of these decisions.” Informing the client of her legal rights and options helps the client to make her own decisions regarding what to do next.
Answer A: (call the other therapist to find out his side of the story) This is not an appropriate response and violates the confidentiality of the client.
Answer C: (report the therapist to the licensing board) The therapist is not required to report this behavior or therapist to the licensing board. It would also be in violation of the client’s confidentiality.
Answer D: (collect additional information about the matter in subsequent sessions) Although it might be helpful for the client to discuss her relationship with her previous therapist with you as her current therapist, this question asked about your ethical obligation, so this option does not answer the question.
A therapist is working with Greg who is also taking medication for a severe mental disorder. The therapist finds out that he has been using a lot of alcohol. Where would be the best place for the therapist to refer to Greg?
To a dual diagnosis setting.
Explanation: Given the potential crisis with Greg, treatment in a dual diagnosis setting is the best choice. Generally, a “dual diagnosis setting” specializes in treating substance use disorders along with another mental disorder.
Answer B: (For in-patient treatment) In-patient treatment is not a bad option, but knowing that Greg has a mental disorder, takes medication for the mental disorder, and is currently using substances, makes a dual-diagnosis setting the best option.
Answer C: (To a therapist specializing in chemical treatment) Referring Greg to a therapist that specializes in chemical treatment is not a bad option, but more intensive and specific services may be needed at this time.
Answer D: (To a psychiatrist) More than likely, the client has a psychiatrist, who prescribed his current medication for the mental disorder. A better option is a referral to a dual diagnosis setting.
A marriage and family therapist is working with Lucy to help her understand why she doesn’t seem to advance in any of the jobs she has held. Lucy has an older brother who is highly successful. Even though they did equally well in school, Lucy seems to underestimate herself and sell herself short in all of her jobs. She states, “I guess I’m just not very smart”. She has been working for free on the weekends as a bookkeeper for a friend for the past five years. Lucy won’t accept payment from him, even though she has a hard time making ends meet. The therapist theorizes that her behavior may be related to a system of beliefs that there must always be a “loser” for every “winner” in sibling relationships. What intervention would the therapist use to highlight the problematic beliefs that Lucy seems to have?
A genogram.
Explanation: A genogram is an assessment tool and intervention used in helping clients become aware of unconscious patterns that they may have inherited from prior generations through the “multi-generational transmission process”.
Answer A: Empty chair is a technique used with Gestalt Therapy to help clients become aware of and integrate aspects of the personality that have been disowned or denied. It places the person in therapy across from an empty chair, as is asked by the therapist to imagine someone of discussion sitting in that chair.
Answer B: (Interpretation of the transference) There is nothing in this question to indicate that transference is present in this issue.
Answer D: (Bring the brother in for a conjoint session) Although bringing the brother in for a conjoint issue could be a possible intervention, there is nothing in the question that suggests any issues or faulty interactions between the brother and client. It only highlights that the brother is successful, and does not answer the question of addressing the systematic and problematic beliefs that the therapist believes Lucy to hold true.
As described in the DSM-5, the level of severity of Substance Use Disorders is based on ________________.
number of symptoms.
Explanation: The DSM-5 distinguishes between three levels of severity of Substance Use Disorders based on the number of symptoms. Mild (2 or 3 symptoms); Moderate (4 or 5 symptoms); Severe (6 or more symptoms).
Answer A: Degree of social impairment is considered to be a group among the characteristic symptoms that result in a failure to fulfill major role obligations at home, school, or work due to recurrent substance use.
Answer C: (the presence of tolerance and/or withdrawal) This is considered one of the four groups of characteristic symptoms under pharmacological criteria, but it does not determine the level of severity.
Answer D: The degree of distress caused by the use of the substance is an important consideration but does not determine the level of severity since it is instead, based on the number of symptoms.
Stephen is age 25, gay, and not in a committed relationship. He asks you if you believe homosexuality is wrong, or if you can support his search for a permanent partner. From an ethical standpoint, you should __________________.
share your values and beliefs and, if you cannot be supportive, offer to refer Stephan to someone who is more comfortable with gay clients.
Explanation: This answer addresses all of the ethical obligations you would need to consider and fulfill when responding to Stephen’s question.
Answer A: (tell him your values and beliefs are unimportant and that you have the clinical skills to help him toward his goals regardless of your own opinions) The client has asked this question implying that understanding the therapist’s values and beliefs regarding his sexual orientation are important to him. Since this question impacts the treatment, the client has the right to know, as well as provided with referrals if needed.
Answer B: (share just enough of your own values and beliefs to allow Stephen to make an informed decision about whether he is comfortable working with you) This doesn’t follow up with allowing the client with alternatives, should he make a decision to go elsewhere for services.
Answer C: (share your values and beliefs only if your theoretical orientation permits self-disclosure) This has nothing to do with theoretical orientation, but more with the therapist being able to provide appropriate services for this client with empathy, non-bias, and objectivity.
When providing therapy to a racially or culturally different client, the therapist should __________________.
ask the client if he or she has any concerns about the difference during an initial session.
Explanation: When working with clients who differ from the therapist in terms of race, culture, or other important characteristics, the best approach is for the therapist to address the difference with them in an initial session.
Answer A: (discuss the difference only if the client raises concerns about it) This could place too much responsibility on the client to bring it up in the sessions, as it is the responsibility of the therapist to open this topic up for discussion. Opening this topic up for discussion gives permission to the client to share any thoughts, feelings, or concerns regarding this issue.
Answer B: (rely on generalizations about the client’s racial or cultural group to maximize the effectiveness of therapy) Relying on generalizations would not maximize the effectiveness of therapy. While some generalizations can be made about the characteristics and treatment preferences of individuals belonging to different racial, cultural, or ethnic groups, it is important not to stereotype individuals or assume that their group membership is a primary contributor to their presenting problem.
Answer D: (be aware that a client’s experiences with prejudice may take the form of paranoia and pathological defensiveness ) This could be a possibility when working with individuals, therefore being aware of this possibility can be important, but having these conversations between a therapist and client can help with these issues or concerns.
You are counseling an 11-year-old girl who tells you she has been physically abused by her mother. As evidence, she shows you the bruises and scars on her back and neck. You are legally required to do which of the following?
Report the suspected abuse to an appropriate authority.
Explanation: You have more than enough information to make a report since therapists are legally required to make a report to appropriate authorities when there is reasonable suspicion that child maltreatment has occurred.
Answer A: (Contact the girl’s parents and request that they contact an appropriate child protection agency.) It might not be appropriate to contact the girl’s parents regarding this situation, and the therapist would not request that the family make a report. The therapist is legally required to report the situation to appropriate authorities.
Answer B: (Investigate the situation to determine whether the girl is telling the truth.) Therapists are not the investigators to determine and substantiate abuse, but instead, are legally required to report possible abuse based on reasonable suspicion.
Answer D: (Turn the child over to an appropriate authority.) This is not the therapist’s responsibility to “turn the child over to an appropriate authority.” The responsibility of the therapist is to report the possibility of child abuse based on reasonable suspicion.
The best thing to say to a new client to help decrease the possibility of premature termination is _______________.
“it will probably feel worse before it feels better”.
Explanation: is often true that clients will feel worse as painful feelings emerge once they have begun making progress in therapy. Clients may feel frustrated by not making progress as fast as they had hoped, or by the realization that issues are more complex than they originally thought. It can be helpful for clients to know and possibly expect these common feelings from the beginning.
Answer A: (“if you stick through the hard times, you will feel better in the long run”) This is a statement that guarantees the client will feel better. Although the therapist can express hope and encouragement, it would not be appropriate to guarantee an outcome.
Answer C: (“you will probably want to leave therapy before it’s complete”) This is not necessarily true and incorrect response.
Answer D: (“it is best to make a commitment to a certain number of sessions in advance”) This is not appropriate. Although a therapist and client might want to discuss possible time frames and expectations, there should not be any commitment needed from the client. A client has the right to terminate at any time throughout treatment.
According to a systems perspective, when an alcoholic husband or father stops drinking ___________________.
the family exerts covert pressure on the husband/father in order to reestablish homeostasis
Explanation: According to family systems theory, a family operates in a way that allows it to maintain its balance or homeostasis, even if the balance is dysfunctional. If an alcoholic family member stops drinking, the balance of the family system is upset. Therefore, other family members will react by encouraging the alcoholic individual, often in covert ways, to reestablish his drinking behavior, thereby restoring the family’s homeostasis.
Answer A: (the family responds positively in terms of their covert behavior) This is not a true statement according to a systems perspective. Usually, the family will respond positively in terms of more visible or apparent behavior.
Answer C: (the family responds positively on a covert level but negativity on an overt level) This is the opposite of what is true. Usually, the family responds positively on an overt level, and negatively on a hidden, or covert, level.
Answer D: (the family exerts covert pressure on the husband/father to conform to social norms) This is a distractor option and does not answer the question as it relates to a systems perspective.
Which of the following would you expect to encounter when treating a client with Borderline Personality Disorder?
Overt expressions of cooperation with covert resistance to treatment
Explanation: This answer best captures the common ambivalence and confusing interactions that often occur between clients with borderline personalities and the therapist.
Answer B: (Violent outbursts) Although a client with borderline personality disorder symptoms is commonly known to have difficulty controlling emotions, violent outbursts are not a common expectation or symptom associated with borderline personality disorder.
Answer C: (Flat affect) Flat affect is not usually a symptom associated with borderline personality disorder.
Answer D: (Cooperation with treatment recommendations) The opposite of this is usually true with a difficulty or refusal to cooperate with treatment recommendations.
As a solution-focused family therapist, the purpose of asking a family questions about circumstances in which the problem does NOT occur is to ____________.
assess the resources and strengths of the family.
Explanation: Discovering evidence of when clients managed to handle challenging situations allows the therapist to assess the resources and strengths of the family.
Answer A: (maintain rapport with the family) This is not an example of establishing rapport. This is a specific intervention used by solution-focused therapists.
Answer B: (change the direction of the interview) The purpose of this intervention is not to change the direction of the interview but to instead find exceptions to the problem.
Answer D: (contextualize the problem) This is not a true statement, and does not describe the intervention in the question.
The therapist is working with a 35-year-old male client that says, “Suppose someone had sex with their 7 year-old daughter. Could they get help in therapy?” The client has a 7-year-old daughter. The therapist should ________________.
assess further to determine if there is sufficient reason to suspect child abuse has occurred.
Explanation: This is the best answer of the options given. Further assessment would help the therapist to determine whether there is reasonable suspicion of child abuse in this case.
Answer A: (file a child abuse report) Further assessment is needed beyond this one statement to determine if a child abuse report should be made.
Answer C: (suggest that he bring his daughter with him to the next session) This would not be appropriate, and is not needed to determine the next steps for the therapist.
Answer D: (call the daughter after the session is over to interview her) This would be inappropriate to involve the daughter in interviewing her after the session, and it would also violate the client’s confidentiality. Further assessment is needed from the therapist to determine the next steps.
An unemployed house painter was disabled at work. He comes in for help with relationship difficulties. He tells you he is diabetic and has been drinking at least a few pints of scotch every day for the last three weeks. While in the first session, he begins to tremble and sweat profusely and tells you he feels faint. What is your first intervention?
Call the paramedics immediately.
Explanation: Although you would be breaking his confidentiality, this situation represents a circumstance in which disclosure would be permissible and necessary to ensure the safety of your client.
Answer A: (Hospitalize him against his will.) There is no information at this time to suggest hospitalizing the client against his will. Hospitalizing someone against his or her will is for someone at a high risk of danger to themselves or others.
Answer B: (Suggest he consider going to the hospital.) A suggestion is not enough in this situation given what information you know, and what is observed.
Answer C: (Call the family and tell them to hospitalize him.) That is an extra step that is not necessary for this situation. It would be best to call the paramedics immediately.
Eric and Emily come to therapy for help with learning how to stop arguing every night over trivial matters. They report to the therapist that they have “tried everything” and are at a loss with knowing how to respond to each other in kinder and more respectful ways. The therapist issues a directive to both of them, instructing them to argue every night for at least twenty minutes. This is called ____________________.
a paradoxical intervention.
Explanation: Prescribing the symptom is a paradoxical intervention used in strategic family therapy in which a therapist recommends individuals or family members to do intentionally what they already have been doing to maintain consciously the problematic activity.
Answer A: An ordeal is also a paradoxical intervention used in strategic therapy that is an unpleasant task that a client must perform whenever a symptom occurs.
Answer C: Unbalancing is a structural therapy intervention that is used to alter hierarchical relationships.
Answer D: Relabeling, also known as reframing, is an intervention to help view behaviors in more positive ways.
When a family is so interdependent that personal boundaries are not apparent, this is referred to as ___________________.
Enmeshment.
Explanation: According to Minuchin, enmeshment results when there are diffused psychological boundaries between individuals or subsystems in a family. Enmeshment produces a loss of autonomy and is characterized by a high degree of resonance and reactivity between individuals.
Answer B: Pseudomutuality is a relationship between two persons in which harmony and agreement cover up deep and damaging interpersonal conflicts that are not confronted openly.
Answer C: Pseudohostility refers to a family’s ability to argue over trivial events while avoiding underlying issues.
Answer D: When a family is mutually withdrawn from each other both psychologically and emotionally, this is referred to as disengagement.
When doing therapy, whether you are working with an individual or with a family, your overall goal
is promoting awareness. You often make a client aware of whether or not he or she appears congruent,
making connections between what the client is saying with words and what the client is saying
with his or her body. During one session, you encourage a client to role-play his “top dog” self. The
client asks you why he has to do “all these silly exercises.” MOST likely, it is your opinion that a
client’s asking questions:
B. blocks the client from making progress in therapy.
Explanation: B IS CORRECT To answer this question, you had to notice that the assessment issues and interventions
used in this case reflect a Gestalt perspective. Gestalt therapists view questions as a way of keeping the
focus of therapy off of oneself and/or avoiding what one is really thinking. Questions are thought to keep
the person “safe and hidden.” The use of questions is, therefore, restricted by Gestalt therapists, and the
therapist would typically ask the client to turn his or her question into a statement.
A. Incorrect - Gestalt therapists would not view asking questions as a “necessary” part of therapy.
B. CORRECT- As indicated above, Gestalt therapists believe that questions can prevent the client from
progressing in therapy. encourages the client to become too personally involved with the therapist
C. Incorrect - According to Gestalt theory, asking questions encourages distance rather than personal
involvement.
D. Incorrect - Gestalt therapists believe that asking questions prevents catharsis, and that questions
actually keep a person stuck in his or her current emotional state.
