AMFTRB MFT Exam Questions

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1.

You are working with a couple, Bill and Sharon, for marital therapy. After finishing your eighth session, Sharon calls you, tearfully disclosing that Bill pushed her against the wall last night in a "drunken rage." She admits this is the first time this has ever happened, and she states that she feels scared that he could really hurt her. 

Based on this information, what should you do NEXT?

  • Validate Sharon's fears and consider referrals for individual therapy for both clients 

  • Make a Tarasoff report based on your duty to warn 

  • Report the domestic violence to law enforcement 

  • Bring Bill to the phone and ask directly what happened 

Correct answer: Validate Sharon's fears and consider referrals for individual therapy for both clients 

Although it might not be the best answer for this situation, it is most acceptable in this case. 

You cannot make a Tarasoff report, as you don't have evidence that Bill intends to hurt her again. 

This is not inherently reportable to law enforcement unless children or elders are being abused (which we don't have evidence of occurring). 

Bringing Bill to the phone to ask what happened is not therapeutically appropriate. 

So, instead, you would validate her fears and consider referrals. You might also help Sharon make a safety plan.

2.

Raul is a therapist working in private practice. He has been working with Thomas and Sara for premarital counseling for several months. At the end of one of their sessions, the couple presents him with an invitation to their upcoming wedding, stating they could not have "gotten to this point" without him. Ethically, Raul should NEXT:

  • Thank the couple for the invitation and outweigh the pros and cons of attending the ceremony 

  • Thank the couple for the invitation, explain why it would be inappropriate for him to attend, but purchase the couple a gift off their registry

  • Thank the couple for the invitation, explain why it would be illegal for him to attend, and continue exploring their motives for wanting him there

  • Thank the couple for the invitation and consider taking them out to dinner in lieu of going to their wedding to celebrate 

Correct answer: Thank the couple for the invitation and outweigh the pros and cons of attending the ceremony 

There are potential ethical issues with every answer, but Raul can certainly outweigh the pros and cons of attending the ceremony (although most therapists would deny the request). 

It would not be appropriate to buy them a gift off the registry, although giving them a small therapy gift may be appropriate. It would also not be illegal for Raul to attend. Taking them out to dinner would not be an appropriate substitution.  

3.

Strategic family therapists often support family members that negotiate and contract with one another to find permissible solutions. You may evaluate this by how well clients:

  • express their desires and reach compromises.

  • express their needs and set defined boundaries.

  • express their fears and discuss remedies.

  • express their frustrations and set emotional limits.

Correct answer: express their desires and reach compromises.

The process of negotiating and contracting typically consists of identifying desires or preferences and identifying helpful compromises.

It may include boundaries, fears, and frustrations, but those are not overly comprehensive, and may only be part of the negotiating and contracting work. 

4.

You are working with Patricia, a 33-year-old woman referred to you for bulimia. She has made significant progress, but in your twelfth session, she discloses that she has "rarely" eaten that week and has been vomiting nearly everything she consumes. She also states that she feels worthless and that life is meaningless.

Based on this information, what should you do NEXT?

  • Assess Patricia for safety and review your release of information to coordinate care with a medical team.

  • Consult with Patricia's medical doctor and dietitian about her symptom decline.

  • Follow your state's laws for hospitalizing Patricia because she is a danger to herself.

  • Explore the triggers for her symptom decline and modify her treatment plan accordingly.

Correct answer: Assess Patricia for safety and review your release of information to coordinate care with a medical team.

Patricia’s worsening symptoms, along with feelings of worthlessness and meaninglessness, suggest a potential safety concern. It is essential to first assess for immediate safety risks, such as suicidal ideation, and then coordinate her care with a medical team given her physical health concerns, such as significant weight loss and vomiting.

Consulting with Patricia's medical team (if she has a doctor or dietitian) is a next step after obtaining the necessary releases and assessing safety, but should not be your immediate action.

Hospitalization is premature at this stage without a full safety assessment to determine if Patricia meets the criteria for hospitalization.

Exploring triggers and adjusting Patricia's treatment plan is important, but secondary to addressing immediate safety concerns and ensuring she receives medical attention.

5.

Which of the following individuals is MOST CLOSELY associated with founding contextual family therapy?

  • Ivan Boszormenyi-Nagi

  • Carl Whitaker

  • Mara Selvini-Palazzoli

  • Michael White 

Correct answer: Ivan Boszormenyi-Nagi

Ivan Boszormenyi-Nagi founded contextual family therapy. 

Carl Whitaker is associated with experiential family therapy. Mara Selvini-Palazzoli is associated with Milan systemic therapy. Michael White is associated with narrative family therapy. 

6.

Harriet (39) is a new client of yours who often wants your approval and advice before making even the smallest decision. It is clear that she feels uncomfortable making choices for herself. She states that this tendency has greatly impacted her at work, as she reports her coworkers are "fed up" with her always coming to them with questions on how to do certain tasks. 

She reports that her husband, Sam (42), often gets annoyed and impatient with her because she acts "so helpless" when it comes to taking care of herself. Harriet is terrified that Sam is going to leave her, and she is willing to do whatever it takes to keep him happy in the marriage. 

Based on this information, you would MOST likely diagnose Harriet with:

  • Dependent personality disorder

  • Borderline personality disorder

  • Social anxiety disorder

  • Separation anxiety disorder

Correct answer: Dependent personality disorder

Harriet shows symptoms of dependent personality disorder (an ongoing pattern of submissive and clingy behavior). 

She does not have symptoms indicating borderline personality disorder. 

While she does potentially show some social anxiety symptoms, it appears that her fears of being separated and being incompetent are more pervasive than how others perceive her. 

We do not have evidence that she becomes frantic or anxious when physically separated from others, nor do we have evidence that she is worried something bad will happen to people she cares about, as is seen in separation anxiety disorder.

7.

There are various different forms of couples therapy, but the top approaches to this form of therapy have some factors in common. 

Which of the following is NOT one of the common ingredients that tends to appear across successful approaches to couples therapy?

  • Helping couples decide whether to stay together

  • Attending to and validating the perspectives of both partners

  • Emphasizing the creation of positive regard, playfulness, and fondness within the relationship

  • Assisting partners with changing the ways they respond to each other, so they can listen and interact more empathically

Correct answer: Helping couples decide whether to stay together 

It is not necessarily important for therapists to decide (or even necessarily consider) whether the couple should stay together. That is ultimately the couple's choice. Successful couples therapy interventions generally do not involve helping couples decide whether to stay together. 

However, therapists should ensure they are validating the perspectives of both partners in a balanced way. 

They should also help partners to recreate positive feelings, fondness, and a sense of playfulness in the relationship. 

Finally, it's important to help partners become more empathetic when responding to each other. These are successful ingredients for couples therapy across various modalities.

8.

When it comes to alcohol-use disorder treatment, the notion of abstinence is BEST described as:

  • Avoiding consuming alcohol in any form at any time

  • Avoiding binge drinking in any form at any time

  • Creating an effective recovery plan to minimize drinking

  • Avoiding alcohol until stabilization occurs

Correct answer: Avoiding consuming alcohol in any form at any time 

Avoiding consuming alcohol in any form at any time is the best definition of abstinence. 

Avoiding binge drinking, avoiding alcohol for a brief period of time, or minimizing drinking might be forms of harm reduction. None fit the definition of abstinence.

9.

John Gottman's 'emotional bank account' concept can BEST be described as:

  • Chronic positive interactions help smooth out rough conflicts.

  • Vulnerability creates a sense of safety within intimate relationships.

  • Partners need to 'give and take' equally when it comes to expressing needs.

  • Expressing primary needs maintains homeostasis. 

Correct answer: Chronic positive interactions help smooth out rough conflicts.

Chronic positive interactions help smooth out rough conflicts is the correct definition of an emotional bank account.

Vulnerability is important, but it does not define the term. Gottman would likely agree with 'giving and taking,' but this is also not the term. Primary needs are a concept from EFT. 

10.

Within the framework of transgenerational family therapy, the concept of rejunction is BEST described as: 

  • Repairing a rupture within a significant relationship

  • Problems associated with safety and trustworthiness 

  • A sense of loyalty to only one parent

  • Avoiding taking sides with any one family member

Correct answer: Repairing a rupture within a significant relationship

Repairing a rupture within a significant relationship is the best definition of injunction. 

Problems associated with safety and trustworthiness are known as disjunction. A sense of loyalty to only one parent is known as a split loyalty. Avoiding taking sides with any one family member is part of neutrality.

11.

You are providing conjoint couple therapy for Tim and Mary. After your fourth session together, Tim calls you to inform you that he has been having an affair with his coworker. He states he wants to leave the marriage. What is the FIRST response you should consider?

  • You should review your no-secrets policy with Tim and discuss the potential constraints of confidentiality. 

  • You should encourage Tim to disclose his affair and plan to leave the marriage to Mary either on his own or by his next conjoint couple session.

  • You should remind Tim of your no-secrets policy and let him know that he can either tell Mary himself or that you will address it in the next session.

  • You should maintain Tim's confidentiality and focus on encouraging him to tell Mary when he feels ready. 

Correct answer: You should review your no-secrets policy with Tim and discuss the potential constraints of confidentiality. 

When it comes to working with couples and families, some therapists have nonsecrecy policies. Other therapists treat each partner's confidences as though that individual was an individual client. Others take on a hybrid approach. However, your policy should be explicitly listed in your informed consent and reviewed with the couple periodically throughout treatment. 

12.

The Early Milan Approach differed from other types of family therapies in that:

  • Sessions were typically held at least one month apart.

  • Treatment only lasted for four sessions in total.

  • Every family member needed to be part of the therapy.

  • Cotherapists facilitated each session. 

Correct answer: Sessions were typically held at least one month apart.

The Early Milan Approach was a brief therapy, but sessions were generally spaced out by one month. 

Sessions were limited to 10 (not 4). These therapists did not require that each family member attend therapy, and cotherapy was not common in this approach. 

13.

You are meeting with a husband and wife for their first conjoint couples therapy session. As the session progresses, it becomes clear to you that there is ongoing physical abuse between the partners. What should you do NEXT?

  • Explain that couples therapy is inappropriate at this time and encourage each partner to seek individual therapy

  • Explain that couples therapy is inappropriate at this time and encourage partners to enroll in anger management classes

  • Offer to see the couple if they agree to sign a contract promising to end all violence 

  • Offer to see each client individually for a few months and then agree to meet together for conjoint sessions 

Correct answer: Explain that couples therapy is inappropriate at this time and encourage each partner to seek individual therapy

When a therapist hears or suspects that intimate-partner violence is occurring, it is not recommended to initiate or continue conjoint couples therapy. It is appropriate to refer each partner to their own individual therapy. 

It may be appropriate to provide referrals for additional support services, such as anger management, but it is not the first course of action and may not be necessary for the victim. A therapist would not typically propose a contract to promise to end all violence. A therapist might offer to see clients individually, but this would not be the next course of action. 

14.

Saanvi (34) is coming to therapy for her third session. She started working with you because she's been feeling increasingly depressed after moving from New Jersey to California last month. She states she isn't sure if she made the right decision, and that she's debating quitting her new job and moving back to her hometown. At times, she feels very sad and finds herself scrolling through social media just to look at what her old friends are doing.

Based on this vignette, you would MOST likely diagnose Saanvi with:

  • Adjustment disorder

  • Acute stress disorder

  • Major depressive disorder

  • Nothing - she does not meet the criteria for any specific condition 

Correct answer: Adjustment disorder

Saanvi's symptoms are related to an identifiable stressor (relocating), making it appropriate for an adjustment disorder diagnosis. The symptoms began within three months of the onset of the stressor (moving), in line with diagnostic criteria for adjustment disorder.

While she may show symptoms of MDD and acute stress disorder, we would have to further assess for more symptoms. She meets enough criteria to warrant an adjustment disorder diagnosis.

15.

You are providing teletherapy for your client and observe as they start sipping from a glass of wine. They acknowledge that it's wine and announce that it feels great to "just have therapy and decompress from the week." 

Ethically, you should NEXT:

  • Let them know you cannot continue the session with them drinking and reschedule for another time

  • Let them know that you need them to abstain from alcohol for all future sessions

  • Let them know that alcohol can make it hard for them to remember what you discuss in therapy

  • Let them know that you cannot maintain confidentiality about their alcohol consumption 

Correct answer: Let them know you cannot continue the session with them drinking and reschedule for another time

Ethically, you should not engage in any therapy while a client is under the influence, as it can impair their judgment and disrupt therapy. It would be appropriate to reschedule. 

You might remind them to abstain from drinking in future sessions and that it can make memory recall challenging, but that would come after letting them know you cannot meet this time. 

Drinking alcohol is not a reason for breaking confidentiality.

16.

You are in a session with your client, Evelyn. You are discussing a minor mistake she made at work. She states, "It was just so bad. I know I'm going to get fired for it. If I check my email now, I bet there's something in there from my boss." A CBT therapist would BEST describe this cognitive distortion as:

  • Magnification

  • Minimization

  • Mind reading

  • Overgeneralization 

Correct answer: Magnification

Magnification is a form of catastrophic thinking where someone greatly exaggerates potential consequences. 

Minimization is the opposite (her saying her mistake was no big deal and nobody would notice). Mind reading is a form of assuming you know how others think or feel (her saying that she knows her boss must hate her). Overgeneralization occurs when you assume something will always happen because it happened once (her saying that she knows she's doomed to always make mistakes at work). 

17.

Claire (32) just gave birth to her first child. You are a therapist who largely practices from a CBT framework. Claire expresses that she feels overwhelmed about knowing when to feed her baby. She states, "I'm a mother, and this should just be intuitive, shouldn't it?" In CBT, her statement is BEST known as a type of:

  • Irrational belief

  • Internal dialogue

  • Dichotomous thinking 

  • Emotional reasoning 

Correct answer: Irrational belief

It is irrational that Claire should intuitively know exactly when to feed her baby. 

Her internal dialogue refers to thoughts/feelings she has about an experience (so her internal dialogue could certainly be shaping this irrational belief). Dichotomous thinking would sound like, "I should always know when to feed my baby." Emotional reasoning would sound like, "I feel like I don't know how to parent correctly. I must be a bad mother." 

18.

Systemic therapists hypothesize that individuals in systems maintain behavior as a product of:

  • The system and themselves 

  • The entire system

  • Themselves

  • Their immediate family-of-origin 

Correct answer: The system and themselves 

Systemic theory states that clients act in ways that maintain behavior within the system and themselves (not just themselves, their family-of-origin, or the system).

19.

You are working with Jeannie, a pregnant 30-year-old woman who is in her second trimester. She states that she has intense cravings for dirt and flaking paint, and you give her a provisional diagnosis of pica. 

Based on this information, you should NEXT:

  • Refer her for an immediate medical evaluation

  • Assess the rationale for her cravings

  • Make a mandated report, as she presents as a danger to herself

  • Discuss alternative foods that may satisfy her cravings

Correct answer: Refer her for an immediate medical evaluation

Pica can be fatal, and it is imperative to seek medical evaluation quickly.

However, you would not make a mandated report in this case, as she does not show imminent signs of suicide or homicide. 

You might review alternative ways she can cope with these cravings, but that is not the first safety concern. 

Likewise, assessing the rationale is not necessarily realistic, as people with pica do not inherently have a specific rationale for their behavior.

20.

Shanna (8) is a good student in school and generally well-behaved. However, her teacher has expressed concerns about how withdrawn Shanna can be at recess. She is extremely quiet and subdued. She seems to show no emotion when her parents drop her off or pick her up. When you set up a meeting with Shanna's mother, Ellen, she states Shanna has always enjoyed playing quietly and that she has "never" cuddled, wanted to be held, or comforted by an adult caregiver. Ellen also indicates that she "dated around a lot" when Shanna was between ages 1-4, until she met Shanna's stepfather. She reports being concerned that Shanna seeing so many different ex-boyfriends and 'father figures' made it hard for Shanna to trust that any adult will really be there for her. Based on this information, you would MOST LIKELY diagnose Shanna with:

  • Reactive attachment disorder

  • Selective mutism

  • Disinhibited social engagement disorder 

  • Generalized anxiety disorder

Correct answer: Reactive attachment disorder

Shannna presents with numerous symptoms of reactive attachment disorder, and this would be an appropriate preliminary diagnosis. 

We have no evidence of other anxiety symptoms or that Shanna doesn't speak, so that rules out generalized anxiety disorder and selective mutism. With disinhibited social engagement disorder, Shanna would be "attaching to everyone" and want to be best friends with seemingly any caregiver (the opposite of which is happening here).