Treatment

Question 1

Behaviors that are controlled by their consequences are referred to as:
Select one:

A.
respondent behaviors.

B.
operant behaviors.

C.
unconditioned responses.

D.
conditioned responses.

Answer 1

Answer B is correct: For the exam, you want to be able to distinguish between respondent and operant behaviors. Respondent behaviors (answer A) are automatically or reflexively elicited by certain stimuli, while operant behaviors (answer B) are voluntarily performed (or not performed) because of the consequences that follow them.

Answer C is incorrect: In the context of respondent (classical) conditioning, an unconditioned response naturally occurs in response to an unconditioned stimulus. In Pavlov’s research, dogs naturally salivated in response to the presentation of food. Salivation was the unconditioned response and food was the unconditioned stimulus.
Answer D is incorrect: In the context of respondent conditioning, a conditioned response occurs in response to a conditioned stimulus after the conditioned stimulus is repeatedly presented in conjunction with the unconditioned stimulus. Pavlov repeated the paired presentation of a ringing bell with the presentation of food to the dogs in his studies. As a result, the dogs eventually salivated in response to the ringing bell alone. In this situation, the bell was the conditioned stimulus and the salivation produced by the bell was the conditioned response.

Question 2

The members of a family you are seeing are very enmeshed with one another, especially the mother and daughter. For example, the mother often answers the questions you ask the daughter and she always sticks up for her daughter whenever the daughter is criticized by her father. As a structural family therapist, you would most likely do which of the following?
Select one:

A.
Ask the mother and daughter to role-play a problem situation, have them change roles and repeat the role-play, and then assign homework designed to help them practice the new way of relating.

B.
Ask the family to role-play a problem situation, have them repeat the situation while you spatially separate the mother and daughter, and have the mother and father come up with ways to recreate the same situation at home.

C.
Ask the family to role-play a problem situation, spatially separate the mother and daughter and have the family repeat the role-play, and assign homework designed to help them practice the new way of relating.

D.
Ask mother and father to change roles as they role-play a problem situation, have the daughter describe a better solution to the problem, and then assign homework designed to reinforce the new way of relating.

Answer 2

Answer C is correct: This answer is the best one because it includes three interventions associated with structural family therapy: enactment (role-playing a problem situation), boundary making (spatially separating the mother and daughter), and therapist assigned homework.
The correct answer is: Ask the family to role-play a problem situation, spatially separate the mother and daughter and have the family repeat the role-play, and assign homework designed to help them practice the new way of relating.

Question 3

You are a cognitive-behavioral therapist and have been seeing Justine and Nelson for their marital problems. The couple owns an interior design business together and, after six years of togetherness, they have been arguing non-stop. Their goal in therapy is to find new ways to communicate. How would you know when it is time to terminate therapy?
Select one:

A.
The couple has learned how to communicate without arguing.

B.
The stated time limit set for therapy has been reached.

C.
Justine and Nelson have altered their unrealistic ideas and expectations about their marriage.

D.
The underlying dysfunctional patterns have changed.

Answer 3

Answer C is correct: Cognitive-behavioral therapy focuses on altering dysfunctional thoughts (e.g., erroneous and unrealistic beliefs) that are contributing to problematic behavior. When Justine and Nelson replace their irrational belief systems about marriage with realistic ideas and expectations and find new ways to communicate by practicing with graded task assignments, therapy will be complete.

Answer A is incorrect: While it would be helpful for the couple to communicate without arguing, cognitive-behavioral therapy is more concerned with thoughts and beliefs about events than with events themselves.
Answer B is incorrect: Cognitive-behavioral therapy does not require adherence to a strict time limit.
Answer D is incorrect: Although this answer addresses “underlying dysfunctional patterns,” it does not as clearly address dysfunctional thoughts as does answer C.
The correct answer is: Justine and Nelson have altered their unrealistic ideas and expectations about their marriage.

Question 4

For a therapist using Kohut’s self-psychology, __________ occurs when the therapist confirms the client’s achievements and other positive characteristics.
Select one:

A.
mirroring

B.
joining

C.
idealization

D.
self-realization

Answer 4

Answer A is correct: Kohut’s self psychology emphasizes strengthening the structure of the “self” through re-activating and working through pathological childhood experiences. Specifically, Kohut believed that two needs must be met for a child to develop a strong sense of self-hood: The mother must “mirror” the child (i.e., consistently recognize, approve of, and admire the child’s expressions and projects) and the father must allow himself to be idealized by the child so that the child is able to identify with someone more capable than himself or herself. In therapy, “mirroring” occurs when the therapist attempts to repair the client’s pathological upbringing by demonstrating appreciation and respect for the client’s expressions, behaviors, etc. It is similar to Rogers’s unconditional positive regard.

Answer B is incorrect: Joining is associated with structural family therapy.
Answer C is incorrect: Idealization is also associated with self-psychology but is not what is described in the question. A self-psychologist allows a client to idealize him or her (i.e., be known to the client) rather than remaining a “blank screen,” so that the client is provided with someone to look up to and admire.
Answer D is incorrect: This is a general term referring to the fulfillment of one’s potential rather than a term used by Kohut.
The correct answer is: mirroring

Question 5

A family therapist working from the perspective of social learning theory is likely to describe intimate partner violence as:
Select one:

A.
a homeostatic mechanism that serves to restore the perpetrator’s control.

B.
the result of a dysfunctional transactional pattern that is related to sex-role polarization.

C.
a learned response to stress that has been reinforced.
Correct

D.
isolation of the marital dyad from outside social (corrective) influences.A family therapist working from the perspective of social learning theory is likely to describe intimate partner violence as:
Select one:

A.
a homeostatic mechanism that serves to restore the perpetrator’s control.

B.
the result of a dysfunctional transactional pattern that is related to sex-role polarization.

C.
a learned response to stress that has been reinforced.

D.
isolation of the marital dyad from outside social (corrective) influences.

Answer 5

Answer C is correct: Social learning theory emphasizes the role of models (e.g., parents) in learning as well as the internal, vicarious, and/or external consequences of a behavior. This answer is the only one that emphasizes learning and consequences and therefore, is the best answer.
The correct answer is: a learned response to stress that has been reinforced.

Question 6

A newly licensed MFT’s new clients are a lesbian couple. The MFT has had very limited training and experience related to the treatment of gay and lesbian couples and should be aware that:
Select one:

A.
gay and lesbian couples have exactly the same problems as heterosexual couples.

B.
a therapist’s comfort level with homosexuality can affect the therapeutic process.

C.
issues of confidentiality differ when clients are homosexual.

D.
exposure to homophobia is usually the most important issue for gay and lesbian clients.

Answer 6

Answer B is correct: A therapist’s attitude toward homosexuality can affect the therapeutic process when he or she is treating a homosexual couple. This is true about many client characteristics (e.g., clients with criminal records, clients engaged in extramarital or premarital sex). MFTs should always evaluate whether personal values will interfere with their ability to provide objective therapy.

Answer A is incorrect: Due to exposure to prejudice and discrimination, gay and lesbian couples deal with issues that heterosexual couples do not ordinarily face. Therefore, although homosexual and non-homosexual couples deal with many of the same problems, they do not deal with “exactly the same” problems. In general, answers that contain absolutes (e.g., “exactly the same”) tend to be wrong.
Answer C is incorrect: Obligations related to confidentiality are essentially the same for all clients and do not vary based on a client’s sexual orientation.
Answer D is incorrect: Although dealing with homophobia may be a problem for many gay and lesbian clients, like all clients, they seek therapy for diverse reasons.
The correct answer is: a therapist’s comfort level with homosexuality can affect the therapeutic process.

Question 7

You lead groups for children whose mother or father recently died. It is important for you to take into account the children’s developmental stages when scheduling the groups, so that you can help them in ways that are consistent with their ability to deal with their loss. For example, you should keep in mind that most children begin to understand that death is permanent during which stage?
Select one:

A.
concrete operational

B.
genital

C.
phallic

D.
preoperational

Answer 7

Answer A is correct: To identify this as the correct answer, you needed to know that most children begin to understand that death is permanent and irreversible between the ages of 7 and 9 and that Piaget’s concrete operational stage occurs between the ages of 7 and 12.

Answer B is incorrect: Individuals age 12 and older are in Freud’s genital stage.
Answer C is incorrect: Freud’s phallic stage occurs between the ages of three and six.
Answer D is incorrect: Piaget’s preoperational stage occurs between the ages of two and seven.
The correct answer is: concrete operational

Question 8

A therapist is treating a client for panic disorder. She has frequent “anxiety attacks” that begin with a tightening in her chest, followed by a pervasive sense of fear, hyperventilation, and occasionally passing out. She says she tried anti-anxiety drugs but had to stop because they “completely zonked me out.” The woman feels hopeless about ever getting better and came to the therapist because he specializes in treating panic disorder. If the therapist adopts Beck’s cognitive approach, he will initially:
Select one:

A.
have the client identify the antecedents and consequences that are controlling her symptoms.

B.
help the client understand how the symptoms are controlling different aspects of her life.

C.
help the client identify the underlying causes of her symptoms.

D.
help the client see how she misinterprets the meaning of her symptoms.

Answer 8

Answer D is correct: As defined by Beck, the “goals of cognitive therapy are to correct faulty information processing and to modify dysfunctional beliefs and assumptions that maintain maladaptive behaviors and emotions” (Comprehensive Handbook of Cognitive Therapy, 1989, p. 28). From the perspective of cognitive therapy, panic disorder stems from catastrophic misinterpretations of bodily sensations and mental experiences. The first few sessions of therapy are aimed at clarifying the nature of the client’s symptoms and how he or she misinterprets them.
The correct answer is: help the client see how she misinterprets the meaning of her symptoms.

Question 9

Your client says that he can’t stop thinking about his ex-girlfriend and, as a result, can’t get any work done. You instruct the client to obsess about his girlfriend for at least two hours each evening. This is an example of which of the following?
Select one:

A.
reframing

B.
symptom prescription

C.
positioning

D.
ordeal

Answer 9

Answer B is correct: Symptom prescription (also known as prescribing the symptom) is a paradoxical technique that involves asking the client to perform the symptom in an exaggerated way. Its goal is to reduce or eliminate the symptom by creating resistance (i.e., by causing the client to resist the instruction) or by helping the client realize the symptom is under his or her voluntary control.

Answer A is incorrect: Reframing involves changing the meaning or frame of reference of a symptomatic behavior so that it can be understood in a new way.
Answer C is incorrect: When using positioning, the therapist accepts and exaggerates a client’s assertions about his or her problems.
Answer D is incorrect: An ordeal involves instructing the client to engage in a disagreeable behavior before or after he or she engages in the symptomatic behavior.
The correct answer is: symptom prescription

Question 10

A wife ignores her husband’s gestures of affection, and then immediately complains that he never acts in a loving way toward her. When he tries to comment on this, she changes the subject. This is an example of which of the following?
Select one:

A.
pseudohostility

B.
reframing

C.
manipulation

D.
a double-bind

Answer 10

Answer D is correct: Double-bind is the term used to refer to the conflict created when an individual receives two conflicting messages. Double-bind communications often consist of a verbal message and a contradictory nonverbal message.

Answer A is incorrect: Pseudohostility is the term used to describe superficial family bickering that blurs greater problems in a family.
Answer B is incorrect: Reframing is a therapeutic technique in which a therapist relabels or redefines a family’s behavior to make family members more amenable to treatment.
Answer C is incorrect: Though we might say the woman is manipulating her husband, manipulation implies a conscious act and it’s not clear that the woman is aware of what she’s doing. Also, “manipulation” is not the best answer because it is not a professional or technical term associated with family therapy.
The correct answer is: a double-bind

Question 11

Marilyn, age 32, was referred to you by the physician who just released her from the hospital. She was hospitalized for eight days after being beaten by her live-in boyfriend who is now in jail. She says she wants to know what she is doing wrong because “this is the fourth guy I’ve been with that has beaten me.” You:
Select one:

A.
teach her about the cycle of violence.

B.
educate her about the typical profile of an abuser.

C.
construct a genogram to trace the history of abusive relationships in her extended family.

D.
educate her about the cycle of violence and the typical profile of a victim and abuser.

Answer 11

Answer D is correct: This question is a reminder to read all of the answers before choosing one. If you did not do this, you might have chosen answer A because it describes an important initial intervention for this situation. Answer D is the best answer since information about the cycle of violence and the characteristics of victims and abusers would help the client understand the dynamics involved in abusive relationships and reduce her self-blame.

Answer A is incorrect: Teaching this client about the cycle of violence is an excellent early stage intervention, but answer D is a better answer.
Answer B is incorrect: Educating the client about the typical profile of an abuser is a good early stage intervention but, again, answer D is a better answer.
Answer C is incorrect: A family therapist might want to determine if there is a history of abuse in the client’s family of origin, but the question states that she was just released from the hospital which suggests that the correct answer is an early stage intervention. Constructing a genogram would likely be a middle stage intervention.
The correct answer is: educate her about the cycle of violence and the typical profile of a victim and abuser.

Question 12

When assessing a client’s behavior, a therapist working from the perspective of Beck’s cognitive therapy would be MOST interested in:
Select one:

A.
the relationship between a client’s emotions and behaviors.

B.
the discrepancy between the client’s actual behavior and his or her ideal behavior.

C.
the environmental antecedents and consequences of the client’s behavior

D.
the way the client perceives his or her own behaviors and the situations in which those behaviors occur.

Answer 12

Answer D is correct: From the perspective of Beck’s cognitive therapy, psychological distress is caused by dysfunctional “automatic thoughts,” or thoughts that arise spontaneously in response to specific stimuli or situations. Automatic thoughts reflect a person’s perceptions of a situation rather than the situation itself.

Answer C is incorrect: A behavior therapist would be interested in the environmental antecedents and consequences of the client’s behavior. Although Beck’s cognitive therapy incorporates behavioral concepts and interventions (and is now usually referred to as cognitive-behavioral therapy), the primary focus is on automatic thoughts and other aspects of cognition.
The correct answer is: the way the client perceives his or her own behaviors and the situations in which those behaviors occur.

Question 13

Your new client has taken a second job to support his family because his wife was severely injured in a car accident and can’t work. The client reports feeling frustrated by this situation and exhausted every day. Right after saying this, the client expresses remorse for complaining about how he feels, given all that his wife has been through. Your initial response is to:
Select one:

A.
let him know that his feelings are normal.

B.
ask him if he has been feeling depressed.

C.
ask about the family’s financial situation to determine if he is able to make ends meet.

D.
briefly explain to him about how family systems operate and how each family member is affected by change.

Answer 13

Answer A is correct: You should “stay with” the client’s feeling for now, which eliminates answers C and D. Because the feelings the client has expressed seem normal for the circumstances, you best initial response should be to let him know that his feelings are similar to those of other people in similar circumstances. Doing so will counteract the client’s perception that his feelings are strange or abnormal. You may also want to determine if the man is depressed (answer B) but only after normalizing his feelings of frustration and exhaustion.
The correct answer is: let him know that his feelings are normal.

Question 14

A client with borderline personality disorder is in the middle stage of therapy and often becomes extremely angry during sessions and screams at you. Your initial response to her anger will be to:
Select one:

A.
directly and strongly confront it.

B.
help the client identify its source.

C.
set limits on her anger in a gentle way.

D.
ignore her angry outbursts.

Answer 14

Answer C is correct: Rapidly shifting emotions are common in individuals with borderline personality disorder. However, since the client is exhibiting “extreme anger,” the best initial response would be to let the client know that you are interested in her feelings but that you will not tolerate abusive behavior.

Answer A is incorrect: Confrontation can be useful when working with clients with borderline personality disorder. However, the response described in answer C is better since it would be less likely to escalate the client’s anger.
Answer B is incorrect: Identifying the source or cause of extreme anger can be useful but not as the initial response.
Answer D is incorrect: Ignoring the angry behavior would not be a useful way to react to the client’s anger.
The correct answer is: set limits on her anger in a gentle way.

Question 15

When working with clients with major depressive disorder, a practitioner of Beck’s cognitive-behavioral therapy is MOST likely to begin therapy with:
Select one:

A.
social skills training.

B.
inpatient treatment and pharmacotherapy.

C.
cognitive restructuring exercises.

D.
behavioral tasks.

Answer 15

Answer D is correct: Beck notes that therapy may begin somewhat differently for individuals with severe versus mild to moderate forms of depression. For clients with severe depression, it may be necessary to start with behavioral techniques that are designed to increase the client’s overall activity level (e.g., graded task assignments). For clients with mild to moderate depression, cognitive techniques are introduced during initial sessions. See A. T. Beck and M. Weishaar, Cognitive therapy, in A. Freeman, et al., Comprehensive Handbook of Cognitive Therapy, New York, Plenum, 1989.

Question 16

During the first session with the victim of domestic violence, a Bowenian therapist would MOST likely:
Select one:

A.
help her rehearse an “escape plan” and provide her with referrals to shelters for abused women.

B.
help the woman identify the ways in which she provokes her husband’s anger.

C.
construct a genogram with the woman to help her recognize multi-generational transmission processes that are contributing to the problem.

D.
insist that the woman go to a shelter when her husband becomes abusive.

Answer 16

Answer A is correct: In this situation, a therapist’s first concern, regardless of his or her theoretical orientation, is the woman’s safety. Of the four answers, this is the one that best addresses this concern.

Answer B is incorrect: A competent therapist would not emphasize the woman’s responsibility for the abuse, at least not in terms of her “provocation” of the abuse.
Answer C is incorrect: While this answer describes a typical Bowenian intervention, it would probably not be the first step when the presenting problem is domestic violence.
Answer D is incorrect: Although this answer does address the issue of safety, “insisting” that the woman go to a shelter is overly directive. Instead, the therapist is more likely to encourage a woman to protect herself and suggest concrete ways for doing so.
The correct answer is: help her rehearse an “escape plan” and provide her with referrals to shelters for abused women.

Question 17

Murray Bowen used the term “undifferentiated family ego mass” to describe the intense interdependence of many dysfunctional families. When working with an interdependent family consisting of a mother, father, and 10-year-old daughter, a Bowenian therapist would probably do all of the following EXCEPT:
Select one:

A.
work only with the mother and father in therapy.

B.
avoid becoming immersed in family conflicts.

C.
work first with the least differentiated family member.

D.
require that family members talk to him rather than to each other.

Answer 17

Answer C is correct: Differentiation is a key concept in Bowen’s extended family systems therapy. However, Bowen sometimes worked first with the MOST (not the least) differentiated family member since this person was most capable of changing, and a change in this person would foster change in other family members.

Answer A is incorrect: A Bowenian would do this since Bowen proposed that, when the most significant system (the spouses) in the family changes, this will affect the entire family.
Answer B is incorrect: This is consistent with a Bowenian approach. Bowen viewed the role of the therapist as that of a “coach” and encouraged therapists to avoid emotional entanglement with the family.
Answer D is incorrect: This is also consistent with a Bowenian approach.
The correct answer is: work first with the least differentiated family member.

Question 18

You are seeing a 30-year-old woman who is very depressed after the breakup of a long relationship. After six weeks, she comes in very excited and tells you she has met a man online. “He could be the one!” she says. Your most appropriate response would be to:
Select one:

A.
change the treatment goals and work with her on developing a healthy relationship.

B.
invite her to bring the man in for conjoint treatment since this will help her begin a healthy relationship.

C.
suggest that she postpone any major decisions about the new relationship until the two of you have completed the work on the loss of her last relationship.

D.
warn her about the dangers of online dating and caution her to be mindful of personal safety.

Answer 18

Answer D is correct: This is the best answer since it is not too directive and takes the client’s welfare into account.

Answer A is incorrect: This intervention seems inappropriate since it feeds into what is likely a fantasy - i.e., the woman’s belief that “He could be the one!”
Answer B is incorrect: This is clearly premature.
Answer C is incorrect: This is too directive and may elicit resistance.
The correct answer is: warn her about the dangers of online dating and caution her to be mindful of personal safety.

Question 19

The client is a 55-year-old woman, whose husband has had a stroke and has recently returned home after six months in a rehabilitation center. The woman is feeling very stressed and reports that her husband is not taking his medication or eating well and that he says he doesn’t want to live anymore. She asks the MFT to please call him and insist that he come to therapy. As a strategic family therapist, the MFT will most likely:
Select one:

A.
tell her to bring him next time, even if he doesn’t want to come to therapy.

B.
suggest she go home and tell him she’s going to help him with his will and estate planning.

C.
invite children and extended family to the next session so they can offer support.

D.
listen empathically and empower her as the caregiver.

Answer 19

Answer B is correct: Strategic family therapists often use paradoxical interventions to foster change in a family system. Encouraging the wife to accept that her husband wants to die is likely to have the paradoxical effect of motivating him to stay alive.

Answer A is incorrect: Forcing the husband to accept help will only encourage his resistance and continue the dysfunctional “more of the same” cycle.
Answers C & D are incorrect: Offering support and listening empathically are not consistent with the directive, almost intrusive approach of strategic family therapy.
The correct answer is: suggest she go home and tell him she’s going to help him with his will and estate planning.

Question 20

A 22-year-old man was required to receive therapy as a condition of his probation. The man has a history of numerous arrests, including arrests for drug possession, shoplifting, and property damage. As a teenager, he was expelled from his high school for beating up a classmate. The client has not been making any progress in treatment with the MFT. The MFT’s best action is to:
Select one:

A.
initiate termination.

B.
attempt to strengthen the therapeutic alliance.

C.
reevaluate the treatment goals and plan.

D.
get input from the man’s probation officer.

Answer 20

Answer C is correct: This answer indicates that the MFT would try to determine why the client is not making progress and then use his or her findings to modify the treatment plan. In other words, the MFT would consider whether the present treatment is the best one for this client or whether it is necessary to switch to another approach or modality.

Answer A is incorrect: Simply ending treatment is not the best first approach for dealing with any client’s lack of progress in treatment. In the case of clients who persistently engage in antisocial behavior, experts specifically recommended that therapists terminate treatment only if the client’s resistance continues after the therapist has tried all other available solutions.
Answer B is incorrect: For this client, attempting to strengthen the therapeutic alliance is unlikely to increase his motivation to change. According to experts, individual psychotherapeutic relationships are almost never effective for changing antisocial behavior. (This is the case even when external controls, such as a court order, are in place.)
Answer D is incorrect: An MFT would not seek treatment input from a probation officer.
The correct answer is: reevaluate the treatment goals and plan.

Question 21

A practitioner of narrative therapy is working with a family that engage in a lot of overt conflict. Family members yell at each other in session and generally disagree about everything. As an initial intervention, the therapist will most likely:
Select one:

A.
have family members write letters to each other.

B.
probe for some exceptions to their problematic behavior by asking opening space questions.

C.
identify and alter the antecedents and consequences that are maintaining the family’s problematic interaction patterns.

D.
determine each family member’s current feelings about their situation by asking scaling questions.

Answer 21

Answer B is correct: Opening space questions are similar to the exception questions used by solution-focused therapists and are used to uncover “unique outcomes” – i.e., to identify times when family members have had some influence or control over the problematic behavior. “Has there ever been a time when you’ve been able to spend time together without arguing?” is an example of an opening space question.

Answer A is incorrect: Letter writing is used by narrative therapists, but it is not an initial intervention and the letters are written by the therapist and given to the clients.
Answer C is incorrect: Identifying antecedents and consequences that are maintaining a problem behavior is an intervention used by behavior therapists.
Answer D is incorrect: Scaling questions are associated with solution-focused therapy and are used to determine a client’s beliefs about his or her progress or readiness to work toward achieving a specific goal.
The correct answer is: probe for some exceptions to their problematic behavior by asking opening space questions.

Question 22

Research has found that Asian American individuals tend to underutilize mental health services. This is believed to be because of cultural values that inhibit self-referral and:
Select one:

A.
encourage independence.

B.
promote emotional release within the family.

C.
produce an unusually low rate of mental health problems.

D.
promote the resolution of problems within the family.

Answer 22

Answer D is correct: Seeking help from mental health professionals can produce a sense of shame for the members of this population. Consequently, traditional Asian individuals are more likely to seek help from elders and other trusted individuals within their own community and to be reluctant to discuss personal or family problems with an outsider, such as a therapist.

Answer A is incorrect: Asian cultural values emphasize family and interdependence.
Answer B is incorrect: Asian cultural values do not encourage a high level of emotional expression.
Answer C is incorrect: There is no evidence that Asian cultural values are associated with lower rates of mental health problems.
The correct answer is: promote the resolution of problems within the family.

Question 23

Your new client has come to therapy because he has not been performing well at work and is afraid he’s going to be fired. The man wants to correct his job performance problems. Assuming that you’re a practitioner of cognitive-behavioral therapy, what is your initial intervention?
Select one:

A.
talk to his supervisor to get additional information about his job performance

B.
ask miracle and exception questions to identify possible solutions to his work-related problems

C.
have him keep a daily journal of his automatic thoughts

D.
identify positive reinforcers that would promote good work performance

Answer 23

Answer C is correct: Identifying automatic thoughts is an initial intervention that cognitive-behavioral therapists do to determine the contributors to a client’s presenting problem.

Answer A is incorrect: This might be useful for obtaining information on the client’s work performance, but you would have to obtain authorization from the client to do so and it might make the client feel unsafe or unsure of the confidential nature of your relationship.
Answer B is incorrect: Miracle and exception questions are used by solution-focused therapists to identify possible solutions to a client’s problems.
Answer D is incorrect: Identifying positive reinforcers is something a behavioral therapist might do to assist this client.
The correct answer is: have him keep a daily journal of his automatic thoughts

Question 24

A 27-year-old man tells his MFT that he has just tested HIV positive. He is afraid to tell his parents, who are very conservative and don’t even know that he is gay. His parents are very religious, and he is sure that they would reject him if they knew. The man has been “out” in many areas of his life since he was 20 when he moved far away from his parents. He says that, because of his diagnosis, he’s very lonely and desperate and is feeling a greater need to connect with his family. The MFT’s best course of action would be to:
Select one:

A.
contact the man’s family.

B.
help the man develop a support system.

C.
reassure the man that contacting his parents may not be helpful at this time.

D.
refer the man to a gay counselor.

Answer 24

Answer B is correct: The client has a serious illness and, because of his diagnosis, is feeling lonely. Although it might be appropriate at some point to explore his options regarding his family, it is more important initially to help him develop some type of support system.

Answer A is incorrect: The MFT must respect the client’s wishes regarding notifying his family and cannot violate his confidentiality.
Answer C is incorrect: It would not be appropriate or productive to reassure a client that contacting his family may not be helpful.
Answer D is incorrect: Unless the MFT is uncomfortable or not competent to work with a gay client who is HIV positive (which is not indicated in the question), there is no reason to refer this man to another therapist.
The correct answer is: help the man develop a support system.

Question 25

An MFT leads a co-dependency group with another therapist. They generally agree on how to run the group and usually get along pretty well. However, there have been times when they have disagreed with each other’s approach. According to Irvin Yalom, open disagreement between co-therapists in group therapy:
Select one:

A.
is harmful under any circumstances.

B.
is beneficial under any circumstances.

C.
can be useful for modeling how disagreements can be resolved.

D.
can be useful in groups that are overly harmonious and cohesive.

Answer 25

Answer C is correct: Irvin Yalom, a leading authority in the field of group therapy, concluded that when co-leaders of a group disagree, they can model effective ways of resolving their disagreement. This is more true after the initial or first stage of group treatment, however, since disagreements can be too disruptive during that initial stage.

Answer A is incorrect: Open disagreements between the co-therapists are discouraged and potentially harmful early in the group’s development, but they are not considered by Yalom to be “harmful under any circumstances.”
Answer B is incorrect: While open disagreement between co-leaders can be beneficial, it is not necessarily “beneficial under any circumstances.” For example, Yalom believed that open disagreement between co-leaders can be harmful if group members are low functioning or the group is in its initial stages and is not stable and cohesive.
Answer D is incorrect: This statement is vague (i.e., what does “overly harmonious and cohesive” mean?) and is not consistent with Yalom’s conclusions about open disagreement between co-leaders.
The correct answer is: can be useful for modeling how disagreements can be resolved.

Question 26

You are working with a blended family that consists of the mother, father, and three adolescent boys. The boys complain that they are not being treated equally by the mother and father. To strengthen the sibling subsystem, you:
Select one:

A.
have the boys set the agenda for the weekly family meetings.

B.
have the boys lead the weekly family meetings.

C.
have the boys decide which brother gets which chore assignments.

D.
advise the parents to spend an equal amount of time with each of three boys.

Answer 26

Answer C is correct: Strengthening the sibling subsystem is associated with structural family therapy. Of the actions given in the answers, having the boys work directly with each other to make decisions about their chore assignments would be the best way to do this.
The correct answer is: have the boys decide which brother gets which chore assignments.

Question 27

Your new client is a middle-aged man who tells you that his wife has recently become passive and withdrawn, is sleeping more than usual, and is rejecting his sexual advances. As this man’s therapist, your initial action would be to:
Select one:

A.
encourage the man to bring his wife to the next therapy session and then work with the couple to identify the reasons underlying the loss of intimacy in their marriage.

B.
call the wife and suggest that she come in for an individual evaluation.

C.
discuss with the man the reasons why he and his wife have grown apart.

D.
recommend that the man encourage his wife to have a physical evaluation.

Answer 27

Answer D is correct: More than one of the actions described in the answers may be appropriate at some time, but the question is asking about your initial action. The client’s wife may have a serious medical condition and this should be checked out by a physician as soon as possible. Even though the wife is not your client, you would want to urge the man to tell his wife to have a physical evaluation.

Answer A is incorrect: Although conjoint therapy may be indicated later, encouraging the man to bring his wife to the next session would not be your initial action in this situation.
Answer B is incorrect: This answer can be eliminated because calling your client’s wife would be a breach of confidentiality, and you should not solicit a client in this way.
Answer C is incorrect: You should first consider the possibility of a medical etiology for the wife’s symptoms.
The correct answer is: recommend that the man encourage his wife to have a physical evaluation.

Question 28

A client comes to see an MFT because she has a fear of elevators and other enclosed spaces and the MFT specializes in treating phobias. At the beginning of the second session, the client tells the MFT that she is a lesbian and wants to see a lesbian therapist. The MFT should:
Select one:

A.
tell the client about her previous experience working with gay and lesbian clients.

B.
refer the client to a therapist who is a lesbian and has experience treating anxiety disorders.

C.
explore the client’s reasons for wanting to be referred to a therapist who is a lesbian.

D.
reassure the client that therapy can be effective even though she is not a lesbian.

Answer 28

Answer C is correct: This is the best answer because the client may have some misconceptions about the MFT or about non-lesbian therapists that the MFT would have a chance to correct. Moreover, exploring the reasons why the client wants to be referred to a lesbian therapist would provide additional information about the client and her experiences.

Answer A is incorrect: Describing her previous experience with gay and lesbian clients would not be inappropriate. However, it would be better to first determine the client’s reasons for wanting to see a lesbian therapist.
Answer B is incorrect: The MFT may end up providing the client with a referral if she determines that doing so is in the client’s best interests or if the client insists on a referral. First, however, the MFT would want to explore the client’s reasons for wanting to see a lesbian therapist.
Answer D is incorrect: In addition to discounting the client’s concerns, this would be unlikely to change her mind.
The correct answer is: explore the client’s reasons for wanting to be referred to a therapist who is a lesbian.

Question 29

When the tension between a husband and wife becomes too great, the wife focuses more on her 17-year-old daughter’s problems, which then makes it easier for the husband and wife to talk to each other. Such emotional triangles are of MOST interest to which of the following family therapists?
Select one:

A.
Satir

B.
Bowen

C.
Haley

D.
Ackerman

Answer 29

Answer B is correct: Emotional triangles (like the one described is this question) occur when a two-person emotional system recruits a third person into the system in order to reduce stress and regain stability. The notion of triangles is most associated with Murray Bowen, who warns therapists not to become emotionally triangulated with family members during the course of therapy.
The correct answer is: Bowen

Question 30

A new client is extremely anxious while talking to his therapist and tells the therapist that he is anxious most of the time. As a practitioner of Beck’s cognitive behavioral therapy, the therapist will conceptualize the client’s anxiety as being the result of which of the following?
Select one:

A.
catastrophizing

B.
a lack of response contingent reinforcement

C.
all-or-none thinking

D.
emotional reasoning

Answer 30

Answer A is correct: Catastrophizing causes excessive worry and anxiety and involves anticipating that events will have negative outcomes and that those outcomes will be catastrophic.

Answer B is incorrect: Although cognitive-behavior therapists acknowledge the impact of the consequences of a behavior on that behavior, they focus more on the role of faulty cognitions.
Answer C is incorrect: All-or-none thinking is also known as black-and-white thinking and involves interpreting things in terms of one extreme or the other – e.g., as “all good” or “all bad.”
Answer D is incorrect: Emotional reasoning occurs when a person believes that what he or she feels must be true – e.g., I feel stupid so I must be stupid.
The correct answer is: catastrophizing

Question 31

n the context of systems theory, which of the following is true about positive and negative feedback?
Select one:

A.
Positive feedback operates to reduce any tendency toward deviation while negative feedback leads to change.

B.
Negative feedback operates to reduce any tendency toward deviation while positive feedback leads to change.
C.
Positive and negative feedback both lead to change, but negative feedback is more efficient than positive feedback.

D.
Positive and negative feedback both lead to change, but positive feedback is more efficient than negative feedback.

Answer 31

Answer B is correct: Negative feedback has also been called “stabilizing” or “leveling” feedback because it serves to maintain a system’s stability or equilibrium. In contrast, positive feedback has also been called “escalating” or “attenuating” feedback because it serves to disrupt a system’s equilibrium and eventually lead to change.
The correct answer is: Negative feedback operates to reduce any tendency toward deviation while positive feedback leads to change.

Question 32

You are a cognitive behavioral therapist who has been working with a depressed, middle-aged man. He is a successful businessman whose wife left him for a younger man. They have two children who are both in their twenties. The man feels that the divorce was his fault and, if he had paid more attention to his wife, they would still be married. In the middle stage of therapy, you will:
Select one:

A.
acknowledge his feelings and current beliefs.

B.
have him write down his automatic thoughts.

C.
encourage him vent his feelings.

D.
work on identifying, testing, and replacing his irrational beliefs.

Answer 32

Answer D is correct: Cognitive behavioral therapists believe that, by changing your thoughts and attitudes, you can change the way you feel and behave. Identifying, testing, and replacing irrational beliefs (cognitive restructuring) is the primary goal of the middle phase of treatment.

Answer A is incorrect: Some contemporary cognitive-behaviorists, such as David Burns, are interested in feelings, but the typical emphasis is on thoughts. In addition, changing maladaptive thoughts and behaviors (not just acknowledging them) is the focus of the middle phase.
Answer B is incorrect: Cognitive behavioral therapists often have a client write down his or her automatic thoughts, but this is most often done in the early stage of therapy.
Answer C is incorrect: Although cognitions are related to feelings, the emphasis is not on the expression of feelings for the sake of release.
The correct answer is: work on identifying, testing, and replacing his irrational beliefs.

Question 33

A couple reports having an increase in problems in their relationship since their youngest daughter left home for college. To foster second order change, the therapist should:
Select one:

A.
help them refocus on spousal rather than parenting tasks.

B.
recommend that each focus individually on personal development in work or hobbies.

C.
normalize their distress as a predictable and temporary transition.

D.
assume that their daughter was a stabilizing force and help them look for other ways to triangle non-pathologically.

Answer 33

Answer A is correct: First-order changes are superficial and involve changes in behavior that do not alter the system, while second-order changes involve an alteration in the structure and functioning of the system. Refocusing the parent’s concerns would help foster second-order change.

Answer B is incorrect: Encouraging individual development would not be as useful as the action described in answer A since the couple is seeking help for their relationship.
Answer C is incorrect: The situation described in the question is a normal developmental transition in the family life cycle, but simply telling them it is normal is not as good as the action described in answer A.
Answer D is incorrect: This is not a “bad” answer but, because it is clearly based on Bowenian theory and the question is not asking about Bowenian theory, it is not the best answer.
The correct answer is: help them refocus on spousal rather than parenting tasks.

Question 34

A young man and woman were referred to you by their priest for premarital counseling. The clients describe frequent “bickering” and “just the usual premarital jitters.” In the second session, the young woman is visibly upset. You smell alcohol on the man’s breath and begin to suspect that he has a drinking problem. How should you proceed?
Select one:

A.
Ask the clients about their alcohol use to bring this issue out into the open.

B.
Wait for one of the clients to raise the issue of alcohol use.

C.
Use indirect methods to test your suspicion so that you avoid damaging the therapeutic alliance.

D.
Confront the man with information about the consequences of heavy alcohol use.

Answer 34

Answer A is correct: Because heavy alcohol use has the potential to harm physical health and psychological and interpersonal functioning, it would be important to determine the extent of the man’s alcohol use as soon as possible. Additionally, if he is under the influence in session, that needs to be addressed. Consequently, of the answers given, this one describes the best way to proceed.

Answer B is incorrect: The clients are unlikely to raise the issue themselves since they haven’t already done so. They may be invested in maintaining alternative explanations for their “bickering” and “jitters.”
Answer C is incorrect: Using a more direct approach (asking the clients about their alcohol use) is not only more likely than an indirect approach to get you the information you need but also models an honest, straightforward way of discussing difficult issues.
Answer D is incorrect: This issue needs to be handled in a sensitive way, and confrontation is not usually effective for eliciting accurate information about a client’s substance use.
The correct answer is: Ask the clients about their alcohol use to bring this issue out into the open.

Question 35

You are referred a new client, who is a well-known singer in a rock band. He appears restless and uncomfortable. He comes into your office wearing mirrored sunglasses, and he leaves them on as he begins talking to you. This makes you uneasy, since you cannot see his eyes and you see your face in his glasses. He then puts his boots up on the edge of your leather couch and lights up a cigarette. You’ve never allowed smoking in your office and you do not have an ashtray. If you are a humanistic-existential therapist, you will most likely:
Select one:

A.
buy an ashtray and set it by the couch for the next session.

B.
immediately comment on his discomfort and your uneasiness.

C.
tell him you do not want him to wear mirrored sunglasses or to smoke in session but do not comment on his discomfort.

D.
make him feel comfortable by asking for a smoke and putting your shoes on the couch.

Answer 35

Answer B is correct: In part, this question assesses your clinical skill in dealing with problematic client behavior and ability to use such a situation therapeutically: This client needs some limits and also needs to process his feelings. Although there are many ways of responding to this type of client behavior, this response is the only one that is process-oriented and typically humanistic-existential. Although you are not setting limits overtly, you are sharing your feelings in a genuine way and inviting the client to do the same.

Answer A is incorrect: This would not allow for an exploration of feelings and violates your own boundaries.
Answer C is incorrect: This is not a process-oriented response. You are setting limits but are not using the situation therapeutically.
Answer D is incorrect: This an avoidance response. You are not being genuine and are allowing the client to violate your boundaries.
The correct answer is: immediately comment on his discomfort and your uneasiness.

Question 36

A client you have been seeing for a few months has started coming late to her sessions. In recent sessions, she has been dealing with family-of-origin trauma issues that she has never dealt with before. The client was abandoned by her parents at the age of three when her mother got heavily into drugs and her father “disappeared.” She lived with various relatives and was sexually abused by her uncle. Eventually, she was placed in foster care and remained there until turning 18. She says that “foster care was no picnic either” and tells you that she lived in six different foster homes between the ages of five and 18. She says, “My childhood was a living hell, and no kid should have to go through what I went through.” The client’s recent tardiness is MOST likely a reflection of which of the following?
Select one:

A.
enactment

B.
reaction formation

C.
resistance

D.
non-compliance

Answer 36

Answer C is correct: Resistance occurs in therapy when a client consciously or unconsciously resists changing his or her behavior or acknowledging or addressing certain feelings or issues.

Answer A is incorrect: Enactment is a technique used in structural family therapy in which the therapist asks family members to re-enact a problematic interaction.
Answer B is incorrect: Reaction formation is a defense mechanism in which a person represses an undesirable impulse or conflict by expressing its opposite.
Answer D is incorrect: Non-compliance describes inaction by a client in response to some behavior prescribed or recommended by the therapist (e.g., homework assigned by the therapist). Sometimes, a client’s resistance is manifested through non-compliance.
The correct answer is: resistance

Question 37

During a session with a couple, the wife expresses concern that she never really had the opportunity to grow intellectually or have a career. The husband responds by saying, “You’re lucky you were able to stay at home. It is a tough world out there and you would not have been a good mother if you had a career.” The MFT, a working mother, finds herself becoming annoyed and angry at the husband’s attitude. The MFT’s feelings illustrate:
Select one:

A.
empathy.

B.
sympathy.

C.
negative transference.

D.
countertransference.

Answer 37

Answer D is correct: Countertransference occurs when a therapist experiences conscious or unconscious emotional reactions to a client. From the perspective of traditional psychodynamic theory, these reactions originate from the therapist’s own unresolved conflicts, which are projected onto the patient.

Answer A is incorrect: Empathy refers to understanding the feelings of another person, usually because you’ve had a similar experience. The therapist may be empathic, but she is also experiencing an intense emotional reaction that seems to stem from her own circumstances rather than the client’s, which suggests that countertransference is taking place.
Answer B is incorrect: Sympathy involves feeling compassion or concern for someone else, even if you do not identify with or understand what the person is going through.
Answer C is incorrect: Transference occurs when a client projects his or her unresolved conflicts and feelings onto the therapist.
The correct answer is: countertransference.

Question 38

During the first session with a woman who is the victim of intimate partner violence, a feminist therapist would most likely:
Select one:

A.
help the woman recognize the social and political forces that are keeping her in the abusive relationship.

B.
help the woman identify the ways in which she provokes her partner’s anger.

C.
insist that the woman go to a shelter for battered women or other safe place.

D.
help the woman identify and rehearse an “escape plan” to use when her partner becomes abusive.

Answer 38

Answer D is correct: The key phrase in this question is “during the first session.” According to Walker, one of the leading advocates of feminist therapy, a primary goal during the crisis intervention (first) phase of therapy is to help the abused woman rehearse an escape plan (“Feminist Therapy with Victims or Survivors of Interpersonal Violence”; in L. B. Rosewater and L. E. A. Walker (Eds.), Handbook of Feminist Therapy, 1985).

Answer A is incorrect: Although helping female clients recognize the impact of oppressive social and political forces on their attitudes and behaviors is an important part of feminist therapy, it would probably not be the first step in therapy when the presenting problem is intimate partner violence.
Answer B is incorrect: Feminist therapists (and most, if not all, other therapists) would not emphasize the woman’s responsibility for the abuse, at least not in terms of her “provocation” of the abuse.
Answer C is incorrect: A feminist therapist would not be likely to “insist” that a woman go to a shelter, although this would probably be discussed as an option.
The correct answer is: help the woman identify and rehearse an “escape plan” to use when her partner becomes abusive.

Question 39

You have been working with Helen, age 53, for three months. At the beginning of the current session, she suddenly announces that she’s ready to terminate therapy. She says, “I’ve done all I can do in therapy, and I’m ready to stop. This will be my last session.” Your best response is which of the following?
Select one:

A.
Tell Helen that, because her decision seems so abrupt, it would be best to continue therapy for at least one or two more sessions.

B.
Urge Helen not to terminate, pointing out that she has not met all of her original goals for therapy.

C.
Discuss with Helen the pros and cons of terminating treatment at this time.

D.
Agree to terminate since Helen believes she’s ready to do so, and this decision rests with the client.

Answer 39

Answer C is correct: Of the response given in the answers, this is the best one. You are respecting the client’s right to make her own decision, not putting undue pressure on her, and using your expertise to help her make the best decision. As noted in answer D, an adult client has the right to leave treatment when she wants to (assuming that doing so would not place her or others in danger). However, when an adult client abruptly tells you she wants to terminate treatment, it’s usually best to discuss the pros and cons of doing so (the exception would be if the client is withdrawing from treatment because of a circumstance over which she has no control). This would help ensure that the client has thoroughly considered her decision. If the client still wants to terminate after this discussion, you must respect her decision and should try to assist her in the transition so that it serves her best interests and meets her needs (e.g., by offering referrals, suggesting future work that the client can do on her own).
The correct answer is: Discuss with Helen the pros and cons of terminating treatment at this time.

Question 40

You have been using systematic desensitization to reduce the unpleasant physiological responses your client experiences when he is alone and away from home. Although this produced a significant reduction in his anxiety symptoms, he recently experienced a recurrence of symptoms when his wife accompanied him on a business trip. Your client says he thinks he’s “absorbing” his wife’s nervousness. As a behavioral therapist, you’re most likely to conclude that:
Select one:

A.
his wife may also have an anxiety disorder.

B.
the return of his symptoms is probably due to changes in behavioral contingencies.

C.
the return of his symptoms is most likely attributable to the emergence of new irrational beliefs.

D.
this is the “boomerang effect” that often occurs following a dramatic change in behavior.

Answer 40

Answer B is correct: From a behavioral perspective, symptoms are elicited and maintained by behavioral contingencies – i.e., the antecedents and consequences (e.g., reinforcement) associated with the symptoms. Consequently, you would want to determine what events preceded his symptoms and what consequences followed them.

Answer A is incorrect: MFTs should never diagnosis a person they have not met and evaluated.
Answer C is incorrect: It may be that the client has irrational beliefs, but a behavioral analysis focuses more on antecedents and consequences than on beliefs.
Answer D is incorrect: The boomerang effect refers to a change in attitude or behavior opposite to the one desired by a persuader. This term is associated with communication theory, not with behavioral therapy.
The correct answer is: the return of his symptoms is probably due to changes in behavioral contingencies.

Question 41

You are using play therapy with a young child and, as you are setting up the playroom, the child becomes unruly. Your best intervention would be to:
Select one:

A.
let the child roam the room on her own.

B.
analyze the game or toy she chooses.

C.
provide some structure and set some limits.

D.
ignore her misbehavior and reinforce her positive behaviors.

Answer 41

Answer C is correct: Although you would want the child to feel free to express herself in play therapy, it is also important to provide some structure so that she feels safe and taken care of and does not hurt herself. Therefore, of the answers given, this is the best one.
The correct answer is: provide some structure and set some limits.

Question 42

Your client has received a diagnosis of anorexia nervosa. She was hospitalized for several weeks and is now back home. You are coordinating your treatment efforts with those of her physician and providing both individual and family therapy. If you are a cognitive therapist, you will focus on which of the following?
Select one:

A.
how the client’s symptoms benefit each family member

B.
the client’s unrealistic evaluations of her body and weight

C.
the meaning of the symptoms for the client

D.
the client’s irrational belief that the “world must be perfect”

Answer 42

Answer B is correct: A primary focus of cognitive therapy for anorexia is on how the symptoms emerge from the client’s faulty beliefs and assumptions. These beliefs are typically related to evaluations of body and weight as well as food and eating. For instance, the client may classify all food according to a rigid dichotomy of “good vs. fattening” or may have underlying and unverbalized assumptions, such as “one’s body shape is a valid determinant of one’s self-worth.” These types of beliefs and assumptions would be the core focus of treatment.

Answer D is incorrect: A cognitive therapist might focus on these types of beliefs as well, but answer B is a better answer because unrealistic evaluations of body shape and weight are directly related to the pathology in anorexia nervosa.
The correct answer is: the client’s unrealistic evaluations of her body and weight

Question 43

You have been seeing a couple in therapy for four months. One of the goals included in your treatment plan was to improve their dysfunctional interaction patterns, and your treatment has included the use of restraining and positioning strategies. Most likely, you are a practitioner of:
Select one:

A.
humanistic-existential therapy.

B.
structural family therapy.

C.
strategic family therapy.

D.
psychodynamic family therapy.

Answer 43

Answer C is correct: Focusing on interaction patterns and using restraining and positioning are characteristic of strategic family therapy.
The correct answer is: strategic family therapy.

Question 44

Bobby has had a good relationship with his therapist, but during one session he begins to act hostile toward her. During this session he says, “You get me so annoyed! You’re just like my mother!” This is an example of which of the following?
Select one:

A.
transference

B.
repentance

C.
countertransference

D.
acting out

Answer 44

Answer A is correct: Transference is the unconscious assignment to others of feelings and attitudes originally associated with important figures (parents, siblings, etc.) from one’s early life. Bobby has transferred feelings he has toward his mother onto his therapist.

Answer B is incorrect: Repentance involves acting a certain way in an effort to reform oneself morally.
Answer C is incorrect: Countertransference occurs when a therapist expresses feelings and attitudes toward a client that were originally associated with a parent, sibling, or other significant person.
Answer D is incorrect: Acting out occurs when a person performs an extreme behavior to express a thought or feeling that the person is not capable of expressing.
The correct answer is: transference

Question 45

In a stepfamily, which relationship ordinarily has the strongest bond?
Select one:

A.
biological parent and child in a dysfunctional family

B.
biological parent and child in a functional family

C.
stepparent and child in a dysfunctional family

D.
stepparent and child in a functional family

Answer 45

Answer B is correct: A normal phenomenon in stepfamilies is for the biological parent to continue to have a stronger (i.e., closer) relationship to his or her child than the step-parent does. In fact, it might be a sign of dysfunction if step-relationships are stronger or more intense than biological relationships.
The correct answer is: biological parent and child in a functional family