MFT practice test, weighted like the blueprint

A therapist in a small practice is about to see a new client with a recent assault charge and a history of explosive anger. Which step BEST prepares for the first session?

1. Decline to take the referral at all
   A history of violence calls for safety planning, not automatic refusal; it is not by itself a contraindication to treatment.
2. Schedule when colleagues are present and agree on an alert signal
   A known risk of violence is managed by planning ahead: seeing the client when others are nearby and agreeing on a signal to call for help.
3. Hold the session after hours so other clients are not disturbed
   Meeting after hours removes the colleagues who could help if the client becomes violent.
4. Meet with the door locked to keep the session fully private
   A locked door blocks the therapist's own exit and keeps help out.

A strategic therapist tells a man with insomnia that on any night he cannot fall asleep within 30 minutes, he must get up and wax the kitchen floor until he feels sleepy. This intervention is BEST described as:

1. Prescribing the symptom
   Prescribing the symptom would tell him to stay awake on purpose; here he is told to do a different, burdensome task.
2. An ordeal technique
   Attaching a task more unpleasant than the symptom (waxing the floor), so that keeping the symptom costs more than giving it up, is Haley's ordeal.
3. A positive connotation
   A positive connotation ascribes a benevolent motive to the symptom; this directive attaches a burdensome task and ascribes no motive at all.
4. A pretend technique
   Madanes's pretend technique asks someone to pretend to have the symptom; nothing here involves pretending.

A 12-year-old consistently sides with his mother against his father. The therapist assigns the parents to go out alone together once a week, leaving the son at home with a sitter. This intervention is BEST described as:

1. A directive that strengthens the parental dyad
   Sending the parents out together is an out-of-session directive with a structural aim: it draws a boundary around the parental dyad and loosens the mother-son coalition.
2. An enactment to unbalance the family in session
   An enactment happens in the session, with the family playing out its interaction in front of the therapist; this is homework done outside.
3. A paradoxical prescription of the son's coalition
   A paradoxical prescription would tell the son to keep siding with his mother; this task works directly against the coalition.
4. A ritual designed to challenge a family myth
   Milan rituals are prescribed sequences meant to challenge a family myth; no myth is named, and the task simply strengthens the parents' bond.

A client asks her MFT for a copy of the process notes the therapist keeps separately from the medical record. Under HIPAA, the therapist:

1. Must release them within 30 days of the request
   The 30-day deadline applies to the designated record set; separately kept psychotherapy notes are not part of it, so there is no duty to release them on that timeline.
2. May lawfully decline to hand them over
   Psychotherapy notes kept separately from the medical record are excluded from the HIPAA right of access, so the therapist may decline them while the rest of the record stays available (state law can grant more).
3. Must release them once copying fees are paid
   Paying a copying fee does not create a HIPAA right to psychotherapy notes; fees apply to records the client is entitled to.
4. Must obtain a court order before releasing them
   No court order is needed: HIPAA lets the therapist decline these notes, and nothing requires going to court before releasing them.

A client asks her MFT for a list of everyone outside the practice who has received her health information in the past year. Under HIPAA, what should the therapist do?

1. List only the disclosures she personally authorized
   Disclosures she personally authorized are the ones HIPAA leaves out of the accounting; listing only those reverses the rule.
2. Provide an accounting of the required disclosures
   HIPAA gives clients a right to an accounting of certain disclosures, such as those required by law, so the therapist provides one (routine treatment, payment and operations disclosures and those she authorized are excluded).
3. Refuse to share the disclosure log
   Clients do have a HIPAA right to an accounting of disclosures; refusing ignores it.
4. Give her a copy of her full clinical record instead
   A copy of the full record shows her care, not who outside the practice received her information.

An MFT consults a colleague about whether a client's statement triggers a duty to protect and decides no action is required. What should she document?

1. Her final decision alone
   Recording only the final decision leaves out the facts and reasoning that show the decision was sound.
2. No entry about the consultation
   Deciding not to act is still a clinical decision about risk; leaving no entry about the consultation means the reasoning behind it is lost.
3. The consultation and her reasoning
   Documenting the consultation, the facts weighed and her reasoning shows how a duty-to-protect decision was reached and protects both client and therapist.
4. The colleague's advice alone
   Recording the colleague's advice alone omits her own reasoning; the decision and the responsibility remain hers.

A new client says her previous therapist had a sexual relationship with her during treatment. She is ashamed and unsure what to do. What should the MFT do FIRST?

1. Advise her to put the past behind her and move on
   Telling her to put it behind her dismisses a serious violation and the harm it caused.
2. Contact the prior therapist to hear his account
   Contacting the prior therapist breaches her confidentiality and puts the new therapist in an investigator's role.
3. File a board complaint without her agreement
   Filing a complaint without her agreement takes control away from a client whose trust was just exploited, unless a specific state law mandates a report.
4. Explore her reactions and explain her options
   She needs support and information first: the therapist explores the harm and explains her options, such as a board complaint; unless a state law requires a report, the choice to file is generally hers.

An MFT receives a letter from the AAMFT ethics committee about a complaint. She plans to resign her membership and ignore the letter. What is the MOST accurate statement about her plan?

1. She may ignore it unless the state board also opens a case
   The AAMFT process does not depend on a state board case; ignoring the letter is non-cooperation under 3.12(g).
2. She should first contact the client who filed the complaint
   Contacting the complainant first can look like pressure on a witness; the right response goes to the committee.
3. Resigning ends the committee's authority over the matter
   Resigning does not end the committee's authority; the investigation continues and any published action notes the attempted resignation.
4. The inquiry continues and she must still cooperate
   The Code says that if a member resigns during an ethics investigation, the committee completes it, and failing to cooperate is itself misconduct (AAMFT 3.12g).

In a family session, an MFT uses the wrong pronouns for a nonbinary 16-year-old, who goes quiet. The teen's pronouns were listed on the intake form. What is the MOST appropriate response?

1. Explain at length why the error happened
   A long explanation makes the moment about the therapist and asks the teen to reassure them.
2. Continue without drawing attention to it
   Ignoring the mistake signals that the teen's identity does not matter; a brief correction draws less attention than leaving the teen hurt.
3. Briefly own the mistake and use the correct pronouns
   Owning the mistake briefly and using the correct pronouns repairs the moment without making the teen manage the therapist's feelings.
4. Ask the parents which pronouns they prefer to use
   The teen's pronouns are already on the intake form; asking the parents what they prefer puts the teen's identity up for a parental vote.

On a Sunday, a client calls her MFT in distress about a fight with her husband. The therapist assesses risk by phone and they agree on a plan. How should the call be documented?

1. Only if the client is billed for the call
   Documenting only when the call is billed ties the record to payment; a risk assessment needs a record whether or not it is billed.
2. No note is needed for calls outside sessions
   Calls outside sessions are clinical contacts too; skipping the note leaves a risk assessment undocumented.
3. In the client's chart with the call's findings
   Every clinical contact belongs in the record, especially a call in which risk was assessed and a plan agreed (AAMFT 3.5).
4. Only in the therapist's personal notes
   Personal notes are outside the clinical record, so the risk findings would be missing where other providers and the record need them.

A marriage and family therapist finds that an online therapist directory lists them as a 'certified sex therapist,' a credential they do not hold. The therapist did not write the listing. What is the MOST appropriate action?

1. Leave it until a client asks about the credential
   Waiting until a client asks lets the misrepresentation mislead people in the meantime.
2. Ask the directory to mark the listing 'in training'
   Labeling the credential 'in training' still advertises a certification the therapist does not hold and has not been shown to be pursuing (AAMFT 9.1, 9.6).
3. Clarify their credentials on their own website instead
   Clarifying on their own website leaves the false credential live where potential clients see it.
4. Contact the directory to have the listing corrected
   AAMFT 9.6 asks therapists to make reasonable efforts to correct false statements made on their behalf, so they ask the directory to fix the listing.

A client tells her MFT she wants to switch to a therapist who shares her cultural background. The MFT believes their work is going well. What is the MOST appropriate response?

1. Persuade her to stay in the current treatment
   Persuading her to stay puts the therapist's view of progress above her choice (AAMFT 1.7).
2. Refer her on without discussing her reasons
   Referring her on without discussing her reasons misses a chance to understand what matters to her and can feel dismissive.
3. Explore the request and help her transfer if she wishes
   Clients choose their therapist: the MFT explores the request without pressure and, if she still wants to switch, supports the transfer with referrals and records on her authorization.
4. Refuse to send records until she finishes her goals
   Holding records until she finishes her goals uses them as leverage and blocks continuity of care.

A marriage and family therapist writing a parenting workbook wants to include several exercises from a colleague's published book. What is the MOST appropriate approach?

1. Credit the source and get permission where required
   Authors credit sources for others' original work and obtain permission when reproducing it substantially (AAMFT 5.9).
2. Use them without credit once the wording is changed
   Rewording a colleague's exercise does not make it the therapist's own; using it without credit is plagiarism.
3. Use them as common professional knowledge
   Published exercises are someone's original work, not common professional knowledge, so they need credit.
4. Thank the colleague in the acknowledgments only
   A thank-you in the acknowledgments does not tell readers which exercises came from the colleague.

Using the McMaster Model of Family Functioning, a therapist notes that family members show little interest in each other's activities most of the time, but become intrusive and smothering whenever someone is in crisis. Which McMaster dimension does this describe?

1. Affective involvement
   In the McMaster Model, affective involvement is how much interest members take in each other, from lack of involvement to intrusive over-involvement, as in this family.
2. Roles
   Roles concern who carries out family functions, such as provision of resources and nurturance.
3. Affective responsiveness
   Affective responsiveness is the ability to respond with feelings of fitting kind and intensity, not how much interest members take in one another.
4. Behavior control
   Behavior control covers the family's rules and standards for behavior, such as rigid or laissez-faire control.

An engaged couple asks for a structured assessment of their relationship strengths and growth areas before they marry. Which instrument is designed for this purpose?

1. Revised Conflict Tactics Scales
   The CTS2 measures how partners handle conflict, including aggression; it is a violence screen, not a premarital inventory.
2. Marital Satisfaction Inventory-Revised
   The Marital Satisfaction Inventory-Revised measures the nature and extent of distress in established relationships.
3. Dyadic Adjustment Scale
   The Dyadic Adjustment Scale measures current relationship adjustment and satisfaction, not premarital strengths and growth areas.
4. PREPARE-ENRICH
   PREPARE/ENRICH (Olson) was built to assess premarital and married couples' strengths and growth areas and to guide relationship education.

Both parents of a 14-year-old work long hours and rarely know where he is after school. When the school calls about his drinking, they say, "He's old enough to handle it." Family members seldom eat together or talk about their days. In structural terms, this family is BEST described as:

1. Disengaged, with rigid boundaries
   Rigid boundaries produce disengagement: little contact, few shared meals and slow parental response even to a teen's drinking.
2. Well-functioning, with clear boundaries
   Clear boundaries combine closeness with autonomy; this family has little closeness and a missed serious problem.
3. Organized around a detouring triangle
   A detouring triangle has parents uniting around a child to avoid their own conflict; these parents are simply absent.
4. Enmeshed, with diffuse boundaries
   Enmeshment is the opposite pattern, with diffuse boundaries and over-involvement in each other's lives.

In a Gottman assessment, a husband cannot name his wife's current work stresses, her closest friends, or what she is worried about this month. She says, "He doesn't know me anymore." Which level of the Sound Relationship House is weakest?

1. Building love maps
   Love maps, the ground floor of Gottman's Sound Relationship House, are each partner's knowledge of the other's inner world: stresses, friends and worries.
2. Creating shared meaning
   Creating shared meaning is the top floor (rituals, roles, goals); the problem here is at the foundation.
3. Turning toward bids
   Turning toward bids concerns responding to a partner's moment-to-moment bids for connection, not knowing her current worries.
4. Fondness and admiration
   Fondness and admiration concern respect and appreciation; the husband's gap is knowledge of her life, not regard for her.

A therapist becomes convinced that a mother's overprotectiveness is the family's problem and stops asking questions that might suggest other explanations. Her supervisor, drawing on Cecchin, urges her to stay open to multiple descriptions of the family. Which principle is the supervisor invoking?

1. Curiosity
   Cecchin recast Milan neutrality as curiosity, a stance of staying interested in multiple descriptions instead of settling on one.
2. The invariant prescription
   The invariant prescription is a fixed directive for parents to go out together secretly; it has nothing to do with staying open to explanations.
3. Unbalancing
   Unbalancing is Minuchin's technique of siding with one member to shift power, not a Milan stance.
4. Positive connotation
   Positive connotation is a Milan intervention that gives everyone's behavior a benevolent purpose, not a stance of openness.

After their divorce, a father complains that he is shut out of his 5-year-old's life. The mother says she wants him involved, but she redoes his packing for the child, corrects how he handles bedtime in front of the child, and schedules the child's activities without consulting him. Which hypothesis BEST describes this pattern?

1. Disengagement by the father
   The father is trying to be involved and is being shut out, the opposite of disengagement.
2. A normal postdivorce adjustment
   Repeated control over the other parent's parenting is a specific pattern to assess, not just normal adjustment.
3. Parental alienation of the child by the mother
   Parental alienation describes a child who rejects a parent under the other's influence; here the child is not rejecting the father.
4. Gatekeeping that limits his role as a parent
   Redoing his packing, correcting him in front of the child and scheduling without him are gatekeeping behaviors that close the door to the father's involvement.

A wife grew up with a mother who was repeatedly hospitalized and a father who was often away. She now becomes panicky and angry whenever her husband travels for work. Which concept BEST links her history to the current pattern?

1. Posttraumatic stress disorder from childhood
   PTSD requires a traumatic event and a specific symptom pattern; separation fear in a relationship does not show that.
2. Attachment fear activated by separation
   Unpredictable early caregiving tends to produce anxious attachment, and her husband's absences reactivate that fear, which EFT reads as an attachment protest.
3. Invisible loyalty to her hospitalized mother
   Invisible loyalty is an unconscious obligation to family of origin; it does not explain panic at separations.
4. Triangulation into her parents' marriage
   Nothing shows she was pulled into her parents' conflict as a third party; the pattern described is fear and anger when her husband leaves.

A 35-year-old man has not spoken to his parents in 10 years and moved across the country to "get away from the drama." He now reports intense conflict with his wife's family. From a Bowen perspective, his distance from his parents MOST likely reflects

1. a sibling-position effect from birth order
   Sibling position (Bowen, drawing on Toman) links traits to birth order; it does not explain ten years of no contact and the same intensity resurfacing with his in-laws.
2. an emotional cutoff from unresolved fusion
   Ten years of no contact to escape 'the drama', with the intensity resurfacing with his in-laws, is Bowen's emotional cutoff: unresolved fusion managed by distance.
3. a healthy, age-appropriate launching from his family
   Healthy launching keeps ties while building independence; total cutoff and conflict resurfacing elsewhere are not age-appropriate.
4. a high level of differentiation of self
   Differentiation means staying in contact while keeping a calm sense of self; cutting off is the opposite.

A couple's conflict began when the husband took a job working three weeks on an offshore rig and one week at home. The wife says, "When he's back he acts like the boss and wrecks our routines." The therapist should MOST directly assess

1. the husband's exposure to trauma at work
   Trauma exposure at work is possible but nothing in the stem points to it; the conflict follows his comings and goings.
2. how family roles shift at each departure and return
   Families with rotating absences reorganize while the worker is away and must readjust at each return, so the shift in roles and authority is the core pattern to assess.
3. the wife's possible depression while alone
   Her mood while alone may matter, but the conflict she describes happens when he returns.
4. whether the husband could find a different job
   Whether he could change jobs is a decision for the couple, not an assessment of the pattern.

A wife tells her husband, "You didn't call when you were late tonight. You're so selfish; you only ever think about yourself." According to Gottman, what turns this statement into one of the Four Horsemen?

1. It includes a request for change
   The statement contains no request for change, and a request would make it a gentler complaint, not a horseman.
2. It attacks his character
   'You're so selfish' attacks his character, which Gottman calls criticism; a complaint stays with a specific behavior.
3. It is said in a raised voice
   Volume is not what defines criticism; the same words said quietly would still attack his character.
4. It raises a specific complaint
   The specific complaint about not calling is what Gottman considers a normal complaint; complaints are not one of the Four Horsemen.

A 4-year-old cries when his block tower falls. Which parent response BEST reflects Gottman's emotion coaching?

1. “Go to your room until you calm down.”
   Sending him to his room punishes the emotion, the disapproving style.
2. “You're sad it fell. Want to rebuild it?”
   Naming the feeling ('You're sad') and then helping him solve the problem is Gottman's emotion coaching.
3. “Stop crying; it's only a pile of blocks.”
   Telling him to stop crying because it's only blocks is the dismissing or disapproving style, which teaches that feelings are wrong.
4. “Here, have a cookie and forget about it.”
   Offering a cookie to forget it is the dismissing style: it distracts from the feeling instead of acknowledging it.

An EFT therapist has tracked a couple's pattern: she criticizes when she feels unseen, and he shuts down when he feels he has failed her. Which statement BEST reflects EFT's stage-one work?

1. "Try saying 'I feel' instead of 'you never' next time."
   Coaching I-statements is behavioral communication training, not EFT de-escalation.
2. "When he shuts down, take a 20-minute break to calm."
   A 20-minute break is Gottman's remedy for flooding, not EFT's work on the cycle.
3. "Let's agree on how often you will talk each evening."
   Scheduling talk time is a behavioral agreement; it changes no meaning of the cycle.
4. "This cycle is the real enemy for both of you."
   Framing the cycle, not either partner, as the enemy is stage-one EFT de-escalation; it lowers blame and unites the partners against the pattern.

A mother's 22-year-old son refuses any help for his heavy drinking. She asks what she can do. Which approach has the STRONGEST evidence for getting him into treatment?

1. A surprise confrontational intervention
   Surprise confrontational interventions (Johnson-style) engage fewer people and often fail because many families do not go through with them.
2. Attending Al-Anon to detach from him
   Al-Anon helps the mother cope but is not designed to get the son into treatment, and it engages fewer drinkers than CRAFT.
3. Waiting until he hits rock bottom
   Waiting for 'rock bottom' is a myth with no evidence and can be dangerous.
4. CRAFT training for the mother
   CRAFT (Meyers and Smith) trains the concerned family member to reinforce sober behavior and invite treatment at good moments, and it engages far more treatment-refusing drinkers than other options.

A 15-year-old brought in by his parents says, "I don't need to be here." What would a solution-focused therapist MOST likely do?

1. Give him a task to notice what goes well this week
   A task to notice what goes well suits a client who already wants change; this teen does not yet.
2. Ask what would get his parents off his back
   A teen who doesn't want to be there is a 'visitor' in SFBT terms, so the therapist looks for a goal he owns, such as getting his parents off his back.
3. Explain how therapy could improve his grades
   Explaining how therapy could raise his grades imposes the parents' goal on someone who has none yet.
4. Explore why he is reluctant to engage in therapy
   Exploring why he is reluctant is problem-focused and treats his stance as resistance; SFBT works with what he does want.

A couple starts therapy one week after the wife discovered her husband's ongoing affair. What should the therapist address FIRST?

1. Steps toward forgiveness and recommitment
   Forgiveness and recommitment are late-stage goals; pushing them in the first week is premature.
2. Crisis containment and whether the affair ended
   Affair-recovery models begin with the crisis: containing the reactions and confirming the affair has ended, because ongoing contact makes conjoint work unsafe.
3. The meaning the affair holds for the relationship
   Exploring what the affair means comes in a later stage, once the crisis is contained.
4. A full disclosure of the affair's sexual details
   Detailed sexual disclosure tends to feed intrusive images and is not a first-week task.

The first anniversary of a teenage son's death in a car crash is two weeks away. His parents and younger sister have been sleeping poorly and snapping at each other. What is the BEST intervention?

1. Avoid mentioning the anniversary in sessions
   Avoiding the anniversary in sessions leaves the family's most pressing issue untouched.
2. Advise them to keep busy and not dwell on it
   Keeping busy and not dwelling leaves each member alone with the dread the anniversary is already causing.
3. Refer the parents for medication now
   Poor sleep and irritability before an anniversary are an expected grief reaction; medication now skips the family work.
4. Plan together how to mark the day
   Planning together how to mark the anniversary, with room for each person's way of grieving, reduces dread and gives the date meaning.

Midway through couple therapy, the wife rates sessions highly, but the husband says he feels the therapist takes her side. What should the therapist do FIRST?

1. Explore his sense of being sidelined
   A split alliance predicts dropout, so the therapist explores his sense of being sidelined openly and nondefensively, then adjusts.
2. Reassure him that the therapist is neutral
   Reassuring him of neutrality dismisses his experience instead of exploring it.
3. Offer a referral to a male therapist
   Offering a male therapist assumes the problem is gender and gives up before exploring what he is experiencing.
4. Meet with him alone to rebuild trust
   Meeting with him alone can deepen the imbalance and create a new secret.

A family reports striking improvement after only two sessions of MRI brief therapy. The therapist would MOST likely:

1. Increase session frequency to build momentum
   Adding sessions raises pressure and can invite a rebound to old patterns.
2. Begin planning termination at the next session
   Planning termination right away skips consolidating a change that is only two sessions old.
3. Add a new goal while the family feels hopeful
   A new goal adds pressure while the first change is still fragile.
4. Caution them to go slow with further change
   MRI therapists restrain change ('go slow') after rapid improvement, which lowers pressure, guards against relapse and lets the family own the change.

While building a genogram, a mother focuses only on the addiction and divorce in her family history and says, "We're a family of failures." What should the therapist do NEXT?

1. Skip the genogram to avoid distress
   Dropping the genogram to spare her distress gives up a tool that can map strengths as well as problems.
2. Look for survivors and strengths too
   Genograms map resilience as well as problems, so asking about members who overcame hardship broadens her problem-saturated story.
3. Finish documenting all the problems first
   Finishing the problem list first reinforces her view that the family is only its failures.
4. Correct her conclusion as distorted
   Labeling her conclusion as distorted argues with her instead of widening the picture through questions.

A couple's youngest child has just left for college, and the parents now fight constantly and say they have "nothing in common." Which life-cycle task should treatment address?

1. Renegotiating the marriage as a dyad
   In the launching stage, with the children gone, the parents must renegotiate their marriage as a two-person system.
2. Accepting new members into the system
   Accepting new members into the system is the task of families with young children.
3. Increasing boundary flexibility for teens
   Increasing boundary flexibility for teens is the task of families with adolescents, the stage they have just left.
4. Accepting shifting generational roles
   Accepting shifting generational roles belongs to families in later life.

Three weeks after a family begins practicing congruent communication, the parents say home feels more chaotic and ask whether therapy is making things worse. According to Satir's change model, the therapist should:

1. return to the family's previous communication.
   Returning to the old communication restores the status quo the family came to change.
2. end therapy and refer the family elsewhere.
   Ending therapy mistakes an expected stage of change for harm.
3. normalize chaos as a stage before integration.
   Satir's change process runs from the old status quo through a foreign element and chaos to integration, so a temporary rise in disorder is expected and normalized.
4. switch to a directive strategic approach instead.
   Switching to a directive strategic model abandons the process at the point where it is working as Satir described.

Late in structural family therapy with parents who rarely backed each other up, which session event would BEST indicate readiness to end treatment?

1. The parents handle a defiant moment together unaided
   Structural therapy aims at a reorganized family that holds without the therapist; parents who meet defiance as a united executive subsystem show the new structure is working.
2. The parents can explain how their emotional distance developed
   Structural change does not depend on insight; explaining how their distance developed shows understanding, not a changed structure.
3. The therapist still unbalances to keep the parents allied
   If the therapist must still intervene to keep the parents allied, the alliance depends on the therapist and is not yet the family's own.
4. The child's symptom eases but conflict still detours through him
   A symptom that eases while conflict still detours through the child means the underlying structure has not changed.

At a review, the parents say therapy is going well, but their teenage son's ORS scores and the therapist's observations show no change. What should the therapist do?

1. Rely on the parents' report as guardians
   Siding with the parents because they are guardians silences the teen, whose own ratings show no change.
2. Rely on the measures as objective data
   Outcome measures are one view among several; treating them as the only truth skips asking the family why views differ.
3. Pause therapy until progress is clearer
   Pausing therapy over unclear progress loses the chance to learn why the family's views differ.
4. Explore the differing views with the family
   Different views of progress are clinical information (the teen may feel unheard), so the therapist explores them with the whole family.

After two sessions, parents whose 13-year-old refused to attend school for months report that every problem has vanished and ask to stop therapy. The therapist should consider that this may be:

1. a second-order change
   Second-order change is a change in the system's rules, which rarely appears after two sessions and does not look like problems vanishing overnight.
2. a unique outcome
   A unique outcome is a narrative-therapy exception to the problem story, not a sudden claim that everything is fine.
3. a flight into health
   An abrupt, total improvement right after therapy begins can be a flight into health, a way to avoid painful work that is often short-lived; it is explored before ending.
4. a positive connotation
   Positive connotation is a therapist's intervention, not something the family reports.

A wife says she is "leaning out" of the marriage and unsure she wants to stay, while her husband wants to work hard to save it. Which approach BEST fits this couple?

1. Discernment counseling
   Discernment counseling (Doherty) is designed for mixed-agenda couples, one leaning out and one leaning in, to decide whether to commit to couple therapy.
2. Individual therapy for him
   Individual therapy for him leaves out the decision both partners are facing.
3. Standard couple therapy
   Standard couple therapy assumes both partners want to work on the marriage; she is not yet sure she does.
4. Divorce mediation
   Divorce mediation fits couples who have already decided to separate.

A therapist wants a brief measure of relationship quality, more sensitive to change than older scales, that each partner can complete before every session. Which is the BEST choice?

1. Dyadic Adjustment Scale, 32-item form
   The 32-item Dyadic Adjustment Scale is the classic measure but too long for weekly use and less sensitive to change.
2. Conflict Tactics Scale (CTS2)
   The CTS2 measures conflict tactics and aggression, not satisfaction.
3. FACES IV family self-report
   FACES IV measures family cohesion and flexibility, not couple satisfaction.
4. Couples Satisfaction Index, 4-item
   The 4-item Couples Satisfaction Index was built with item response theory to be precise and sensitive to change, and it is short enough for every session.

In multisystemic therapy (MST) for a 15-year-old with repeated arrests, which outcome MOST clearly shows that treatment succeeded?

1. He completes a residential treatment program
   Residential placement is what MST tries to prevent, so completing such a program signals the opposite of success.
2. The family attends weekly office sessions reliably
   MST is delivered mainly in the home and community, and attendance is a process measure, not an outcome.
3. He stays at home and in school with no new charges
   MST is a home- and community-based model whose outcome targets are keeping youth at home, in school and out of the justice system, so living at home with no new charges marks success.
4. He gains insight into the roots of his anger
   Insight into anger is not an MST target; MST measures change in behavior and in the youth's home, school and peer context.

For six weeks a family has arrived at each session with a new crisis, and the agreed treatment goals are never addressed. What should the therapist do?

1. Revisit priorities with the family and refocus
   A weekly new crisis calls for stepping back with the family to revisit priorities and agree on a focus, which may reveal a pattern worth treating.
2. Follow each week's crisis as it comes up
   Following each week's crisis keeps therapy reactive and the agreed goals untouched.
3. Refuse to discuss anything but the original goals
   Refusing to discuss anything else ignores what the family brings and can damage the alliance.
4. Refer the family to a crisis service instead
   Referring to a crisis service misreads a pattern of distraction as a need for emergency care.

At the last family session, a 10-year-old asks whether she can keep emailing the therapist after therapy ends. What is the MOST appropriate response?

1. Agree to keep answering her emails afterward
   Promising to keep answering her emails blurs whether therapy has ended and bypasses her parents.
2. Explain how her family can reach the office later
   Termination includes a clear, child-friendly explanation of how the family can reach the office or return if needed.
3. Tell her that all contact must end for good
   Telling her contact must end forever is harsh and untrue: the family can come back.
4. Give her a personal number for emergencies
   A personal number creates a private channel outside the professional relationship and around the parents.

At the last session, a Bowen therapist and client review the three-generation genogram they built at intake. The MAIN purpose is to:

1. complete the family history for the clinical record
   Completing the record is incidental; the review is a clinical step, not paperwork.
2. identify relatives whose disorders need diagnosis
   Diagnosing relatives who were never evaluated is outside the purpose of the review and inappropriate.
3. decide which relatives she should stop contacting
   Deciding whom she should stop contacting is not what a closing genogram review is for; it reviews patterns she has changed.
4. highlight family patterns she has changed or now manages
   Reviewing the genogram at the end helps her see the multigenerational patterns she has changed and plan how to keep managing them.

An in-home family therapist arrives for a scheduled session and finds the father intoxicated, shouting at his wife and holding a handgun at his side. The children are in another room. What should the therapist do FIRST?

1. Ask the mother to take the gun from him
   Asking the mother to take the gun puts her at serious risk.
2. Leave and call the police from outside
   An intoxicated, angry man holding a gun is immediate danger, so the therapist leaves and calls the police from a safe place; they can protect the family.
3. Stay and try to calm the father down
   Staying to calm an armed, intoxicated man puts the therapist in harm's way with no means of protecting anyone.
4. Take the children out of the house with her
   Moving through the house to take the children out could escalate the father's anger and endanger everyone.

Two families face the same job loss. One copes, and the other falls into crisis. According to Hill's ABC-X model, the difference is MOST influenced by

1. the number of children in each family
   Number of children is not one of the model's factors; it matters only through resources and perception.
2. whether either family had prior therapy
   Prior therapy is not part of the model; at most it is one possible resource.
3. each family's resources and view of the loss
   In Hill's ABC-X model, crisis (X) depends on the stressor (A), the family's resources (B) and its perception of the event (C); with the same stressor, resources and perception explain the difference.
4. the objective severity of the job loss
   The stressor is the same job loss for both families, so its objective severity cannot explain the difference.

During a session, a mother and her 17-year-old son begin shouting at each other. The son stands and moves toward the door, saying he's done. What should the therapist do FIRST?

1. Calmly ask both to pause and bring the intensity down
   When escalation threatens the session, the first step is to slow things down so everyone can think; the exchange can be processed afterward.
2. Encourage them to keep expressing their anger fully
   Encouraging full venting tends to raise arousal further instead of resolving anything.
3. Point out that this is their usual pursue-withdraw cycle
   Naming the cycle at the peak of escalation is not heard, can sound like blame, and does nothing to stop the son from walking out.
4. Let the son leave and continue with the mother alone
   Letting the son walk out ends his part in the session and leaves the conflict unresolved.

After a 16-year-old dies by suicide, the high school asks an MFT to help plan the response for students. Which approach BEST reduces the risk of further suicides?

1. Create a permanent memorial in the school hallway
   A permanent memorial can glamorize the death; postvention guidelines favor living memorials and time-limited remembrances.
2. Avoid any mention of suicide so students are not upset
   Avoiding any mention of suicide leaves students to rumor and keeps at-risk peers from being identified.
3. Identify and reach out to vulnerable peers individually
   After a youth suicide, close friends and vulnerable students face higher risk through contagion, so postvention screens them and reaches out individually.
4. Hold a large assembly that describes how the student died
   Describing how the student died at a large assembly spreads method details and raises contagion risk.

In a separate intake interview, a woman reports that her husband has strangled her, owns a gun, and has threatened to kill her if she leaves. The therapist wants a validated instrument designed to estimate her risk of being killed by her partner. Which instrument is MOST appropriate?

1. The Dyadic Adjustment Scale
   The Dyadic Adjustment Scale measures relationship adjustment, not danger.
2. The Columbia Suicide Severity Rating Scale
   The Columbia Suicide Severity Rating Scale assesses her own suicide risk, not the risk her partner will kill her.
3. The Danger Assessment
   Campbell's Danger Assessment was developed to estimate the risk of intimate partner homicide and weighs strangulation, gun access and threats to kill heavily.
4. The Revised Conflict Tactics Scales
   The CTS2 measures the frequency of conflict tactics and aggression, but it was not designed to estimate homicide risk.

In separate interviews, a wife reports that her husband monitors her phone, controls all the money, and has threatened to take the children; she has twice slapped him back when he grabbed her. Using Johnson's typology, the husband's violence is BEST classified as:

1. Situational couple violence
   Situational couple violence arises from escalating conflicts without a general pattern of control, which this husband clearly has.
2. Violent resistance
   Violent resistance describes her slapping back, not his pattern of control.
3. Mutual violent control
   Mutual violent control requires both partners to be controlling and violent; she resists control rather than exercising it.
4. Intimate terrorism
   Violence embedded in a broader pattern of coercive control (monitoring, money, threats about the children) is what Johnson calls intimate terrorism.

A 14-year-old from a family that views mental illness as shameful hints that she has thought about hurting herself, then quickly adds that her parents must never find out. What should the therapist do FIRST?

1. Wait to ask more until greater trust is built
   Waiting to build trust delays a safety assessment after she has already hinted at self-harm.
2. Ask a respected elder to speak with her about it
   Bringing in an elder discloses her confidence to a third party before her risk is known.
3. Assess her risk in culturally sensitive terms
   Hints of self-harm are assessed now, in language that respects her fear of family shame; the safety assessment cannot wait.
4. Educate her family about mental illness first
   Turning to family psychoeducation first delays her safety assessment and risks exposing what she asked to keep private.

Which of the following represents a first-order change in a family?

1. Parents invite their teen to help set the curfew rules
   Letting the teen help set curfew rules changes how rules are made, which is second-order change.
2. A child is moved out of the middle of parental conflict
   Removing the child from the middle of parental conflict reorganizes the family structure, which is second-order change.
3. Parents swap grounding for loss of phone privileges
   Swapping grounding for loss of phone privileges is change within the existing rules (parents decide, teen complies): first-order change.
4. A couple shifts from pursue-withdraw to mutual engagement
   Moving from pursue-withdraw to mutual engagement changes the pattern itself, which is second-order change.

Parents bring their 10-year-old for therapy because of tantrums. The therapist learns the tantrums flare mostly on nights the parents argue about the father's drinking. From a systemic view, the child is BEST understood as:

1. The symptom bearer of family stress
   Tantrums that flare when the parents argue about drinking mark the child as the identified patient, the symptom bearer of family stress.
2. The primary source of family conflict
   Calling the child the source of conflict reverses the sequence: the tantrums follow the parents' arguments.
3. The member who needs treatment first
   Treating the child first keeps the focus on him and misses the parents' conflict that drives the symptom.
4. The family's parentified caretaker
   A parentified child takes on adult caretaking roles; tantrums are not caretaking.

In a first session, a therapist sees two parents repeatedly contradict each other about their young children's rules while the children escalate. Which step should the structural therapist take FIRST?

1. Join each parent and track the pattern
   Structural therapists join first, building an alliance with each parent and tracking the sequence before challenging the structure.
2. Direct the parents to agree on rules now
   Getting the parents to agree on rules is a sound restructuring goal, but directing it before joining tends to provoke resistance.
3. Explore each parent's family-of-origin rules
   Family-of-origin rules are Bowen territory; structural therapy works with the interaction in the room.
4. Start a token economy for the children
   A token economy targets the children's behavior and skips the parental conflict driving it.

During a couple session, a devout wife asks the marriage and family therapist, "Are you religious? I need to know you won't judge our faith." What is the MOST appropriate response?

1. Explain that the therapist's beliefs are off-limits
   Declaring the therapist's beliefs off-limits sidesteps her worry and can sound defensive.
2. Explore her concern about how her beliefs will be seen
   The question signals a worry about respect for the couple's faith, so the most helpful response addresses that worry directly.
3. Describe the therapist's own religious practices
   Describing the therapist's own practices shifts the focus to the therapist and may introduce the therapist's beliefs into the couple's work.
4. Interpret the question as resistance to treatment
   Reading a reasonable question as resistance pathologizes a concern about being respected.

A woman stays calm and decisive while her marriage is going well, but becomes anxious and indecisive whenever her husband is critical. A Bowen therapist would say her calm periods reflect her:

1. Basic level of differentiation of self
   Basic differentiation is stable and does not depend on relationships; her calm collapses under criticism, so it is not basic.
2. Functional level of differentiation
   Bowen's functional differentiation rises and falls with the relationship climate, as her calm does while the marriage goes well.
3. An I-position within the marriage
   An I-position is a single stance a person takes; her calm periods are a state that depends on the marriage.
4. A family projection process
   The family projection process is parents passing their anxiety onto a child; it says nothing about her own steadiness rising and falling with the marriage.

A therapist describes a husband's physical violence as "part of a circular pattern the couple co-creates." A feminist family therapist would criticize this framing MAINLY because it:

1. Obscures power and his responsibility for the abuse
   Feminist critics (Goldner, Hare-Mustin) argued that circular causality makes partners look equally responsible and hides gendered power and the perpetrator's accountability.
2. Gives too little attention to family strengths
   Family strengths are not what feminist critics say this framing misses.
3. Neglects the couple's multigenerational patterns
   Multigenerational patterns are a Bowen concern; the feminist critique targets power and responsibility.
4. Overlooks the husband's individual diagnosis
   Individual diagnosis is not the feminist objection; it would locate the problem in pathology rather than in power.

A narrative therapist asks a mother who feels ashamed of her anger, "Where did you learn that a good mother never feels resentment, and who benefits from that idea?" This question is BEST described as:

1. Asking a circular, relational question
   A circular question maps relationships and reactions among family members, not the cultural roots of a belief.
2. Challenging a cognitive distortion
   Challenging a cognitive distortion tests whether a thought is accurate or logical; the question asks where it came from and whom it serves.
3. Externalizing the problem
   Externalizing names the problem as an entity outside the person; here a cultural idea is examined.
4. Deconstructing a dominant discourse
   Tracing a belief to its cultural origins and asking whom it serves is narrative deconstruction of a dominant discourse.

Divorcing parents ask what will MOST protect their children's long-term adjustment. Research points most strongly to:

1. Waiting until the children are older
   Waiting until children are older does not protect them; conflict levels matter more than age at divorce.
2. Delaying either parent's repartnering
   Repartnering timing is a smaller factor than the level of conflict between the parents.
3. Keeping interparental conflict low
   Divorce research consistently finds that ongoing interparental conflict, especially conflict children see or are caught in, is the strongest predictor of their adjustment.
4. Choosing sole rather than joint custody
   Custody type matters less than conflict; sole custody does not protect children from ongoing hostility.

A marriage and family therapist wants to offer a sliding fee scale. Which approach is MOST consistent with ethical practice?

1. Reduce fees only for clients who ask for one
   Offering reductions only to those who ask favors assertive clients over equally needy ones who stay silent.
2. Set each reduction by personal impression
   Deciding case by case on personal impression invites bias and makes fees unpredictable for clients.
3. Use the same written criteria for every client
   A sliding scale is fair when it rests on consistent written criteria disclosed in advance, so clients with similar finances pay similar fees. That keeps the arrangement from becoming arbitrary, discriminatory or exploitative.
4. Charge less for simpler presenting problems
   Problem complexity has nothing to do with a client's financial need, which is what a sliding scale is meant to address.

After separate screening interviews, a couple reports one mutual shoving incident a year ago. Neither partner fears the other, there is no coercive control or substance misuse, and both want couple therapy. What is the MOST appropriate plan?

1. Standard couple therapy without safeguards
   Standard couple therapy without added safeguards skips the continued safety monitoring that any history of violence requires.
2. A batterer program for the husband first
   A batterer intervention program targets one partner's pattern of controlling violence; here the shoving was mutual and there is no control or fear.
3. Refuse conjoint work for this couple
   Refusing conjoint work treats every incident of violence alike; research separates low-level mutual violence without fear or control from patterns where conjoint work is contraindicated.
4. Conjoint work with a specialized IPV protocol
   After separate screening, a single mutual shoving incident with no fear, coercive control or substance misuse is low-level conflict-driven violence, for which conjoint work with a specialized protocol and ongoing safety checks has research support (for example, Stith's domestic violence-focused couples treatment).