AMFTRB MFT Exam Questions

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21.

Paul is a 63 year-old homeless male who was referred to therapy after being released from jail. Paul comes to your office looking fairly disheveled, and he tells you that he often hears voices, stating that God commands him what to do, and that the commands aren't always "very nice." Paul has a flat affect when he tells you this. He then tells you that he can see a demon sitting in your office corner. His chart indicates he has been hearing voices since he was an adolescent. Based on this information, you would MOST likely diagnose Paul with:

  • Schizophrenia

  • Schizoaffective disorder

  • Brief psychotic disorder

  • Delusional disorder 

Correct answer: Schizophrenia

Paul meets the criteria for schizophrenia, as he shows evidence of hallucinations, delusions, and negative symptoms (flat affect). 

He does not indicate a depressive episode (which is necessary for schizoaffective disorder). He has more criteria than would justify for brief psychotic disorder and delusional disorder. 

22.

The Galveston Family Institute takes all the following stances when it comes to the therapist's tasks, EXCEPT:

  • Embrace the significance of psychoeducation 

  • Embrace a curious, not-knowing stance

  • Embrace the client's perception of reality

  • Embrace open, conversational questions 

Correct answer: Embrace the significance of psychoeducation 

While psychoeducation may inherently be a part of any therapy work, it is not a listed stance according to the Galveston Family Institute (GFI). 

However, embracing curiosity, the client's perception of reality, and conversational questions are all important tenets.

23.

All the following represent unintentional or intentional ways therapists perpetuate gender issues, EXCEPT:

  • Asking clients about their internal experiences as it relates to their gender

  • Subscribing to patriarchal beliefs about men and women

  • Minimizing toxic male behavior

  • Expecting women to make more efforts than men to change behavior

Correct answer: Asking clients about their internal experiences as it relates to their gender

Therapists can (and should!) ask about how gender affects their client's thoughts, values, and behaviors. 

The remaining answers all represent potential ways therapists may maintain problems with gender beliefs. 

24.

Your client, Steve, a middle-aged male, comes to your office with a gun. You are not sure if it is loaded, but your client has a history of violence and currently presents himself as agitated with you. 

At one point, he says, "I really hate therapists. You always think you know what's right. The world needs more justice." He strokes his gun as he says this, and you feel an acute sense of panic. You know he's shot someone before, although it was a very long time ago.  

Based on this information, what should you do NEXT?

  • Get yourself in a safe location and call the police

  • Tell Steve you have to make a mandated report because you feel unsafe

  • Ask Steve to elaborate on what he means by the world needing more justice

  • Let Steve know that you cannot see him for therapy anymore

Correct answer: Get yourself in a safe location and call the police 

Steve presents as a risk of hurting you, and you have some suspicion that he may act on his urges. At this point, you need to get yourself to safety and call the police. 

You wouldn't just tell him you need to make a mandated report (as this might make him feel more agitated). 

You wouldn't want to engage in the conversation by asking for further clarification or telling him you can't see him for therapy anymore (he's already holding the gun, and you feel panicked).

25.

You are a solution-focused therapist. It is your sixteenth session working with Micah, a 22-year-old male, referred to you for social anxiety disorder. 

You believe Micah has made significant progress. However, he still reports feeling anxious in most social settings, although he states that he does have more insight into the problem. He also is more mindful of his triggers and ways to cope with them. That said, his anxiety continues to affect his work performance and poses challenges in his dating life. 

Based on this information, you should proceed with treatment by:

  • Continuing to work with him on his social anxiety disorder 

  • Terminating treatment, as he has made significant progress toward his goal

  • Terminating treatment, as he has surpassed the number of sessions solution-focused therapists allocate for treatment

  • Revising his treatment goals to reflect his new progress in managing his social anxiety disorder 

Correct answer: Continuing to work with him on his social anxiety disorder 

Solution-focused therapists generally end treatment when the problem is fully resolved (not just when making significant progress). That is not the case right now. 

There is no set number of sessions allocated for this kind of treatment. 

You might modify the treatment goals if new information presents itself, but that is not apparent at the moment.

26.

As a structural family therapist, you would focus on intervening with a family when:

  • You have joined and accommodated and mapped the family structure.

  • You have joined and accommodated, but before you map the family structure.

  • You have joined and accommodated, but before you map the influence of the problem.

  • You have joined and accommodated and won the battle for structure.

Correct answer: you have joined and accommodated and mapped the family structure.

Intervening happens after you have joined and accommodated and mapped the family structure. 

You wouldn't intervene before mapping the family structure. Mapping the influence of the problem is a narrative family therapy intervention. Winning the battle for structure is a symbolic-experiential intervention. 

27.

A therapist might recommend premarital counseling for a young, engaged couple for all of the following reasons EXCEPT:

  • Eliminating tension within the relationship

  • Improving assertive communication

  • Gaining clarity on shared values 

  • Expressing individual needs within the relationship

Correct answer: Eliminating tension within the relationship

While reducing tension might be a goal, a therapist would likely not expect "eliminating tension" as a viable outcome.

The remaining answers all represent appropriate goals for premarital counseling. 

28.

You are an Imago relationship therapist working with Kyle and Anna, a newly-married couple. Kyle does not show up for the second session, and Anna tells you it's because he's been backed up at work. She states that she is willing to meet with you individually and continue talking about their ongoing stressors. Based on this information, you should do what NEXT?

  • Decline meeting with Anna because Kyle is a pivotal role in her healing process 

  • Meet with Anna and continue working towards your established treatment goals

  • Meet with Anna because Imago relationship therapists work with whoever arrives for the session

  • Decline meeting with Anna because you need Kyle's consent to meet with her individually 

Correct answer: Decline meeting with Anna because Kyle is a pivotal role in her healing process 

Imago relationship therapists rarely work with just one partner, as both partners represent key agents in the healing process. They don't just work with whoever shows up. 

Therefore, you would not meet with Anna to work towards particular treatment goals. However, you wouldn't decline just based on consent, as we don't know what consent the couple has (or has not) agreed to at this time.  

29.

Chris and Mary have been married for six years and are entering couples therapy with Patrice, a marriage and family therapist. Mary states that she is concerned about Chris's drinking. Chris insists that Mary is overreacting and that he drinks occasionally to decompress after work. Patrice conducts a more thorough assessment of Chris's drinking and realizes he meets the criteria for alcohol use disorder. At this point, Patrice should do what NEXT: 

  • Refer Chris for individual alcohol treatment

  • Require that Chris maintain abstinence for the duration of couples therapy

  • Refer Chris to AA 

  • Assess Mary's drinking habits to see if she also meets the criteria for alcohol use disorder 

Correct answer: Refer Chris for individual alcohol treatment

Ethically, therapists need to refer clients to appropriate substance use treatments once they discover the presence of a substance use problem. 

She might recommend AA as a supplementary approach, but it would not be sufficient. She might assess Mary, but we have no information that Mary struggles with drinking. She would not require abstinence as a specific couples therapy treatment goal. 

30.

Which of the following is FALSE when it comes to divorce mediation among separating couples? 

  • Therapists should avoid talking about financial issues altogether.

  • Therapists trained in divorce mediation may support clients in making financial decisions.

  • Therapists should refer clients to appropriate professionals for financial issues.

  • Therapists may discuss with clients how the financial implications of divorce could affect affording therapy.

Correct answer: Therapists should avoid talking about financial issues altogether.

Financial issues can be an important part of therapy, especially when working with divorcing clients. It's certainly appropriate to explore their stress or concerns.

However, for specific financial questions, therapists need to refer to another professional. Therapists might discuss how divorce could impact finances with their clients should the need arise. Therapists trained in divorce mediation can offer guidance in making financial decisions.

31.

Which of the following is NOT one of John Bowlby's attachment categories?

  • Uncertain attachment

  • Secure attachment

  • Insecure attachment

  • Disorganized attachment 

Correct answer: Uncertain attachment

Uncertain attachment is not one of Bowlby's attachment categories. 

His categories include secure, insecure, and disorganized attachment styles.

32.

You are a narrative family therapist working with a couple, Brian and Pauline. They cite financial stress as their main source of tension in the marriage. Brian states that Pauline is too frivolous with their money, and Pauline argues that Brian is too controlling over it. Given this information, what would you aim to do NEXT with this couple? 

  • Help the couple externalize and name their financial problems

  • Help the couple rewrite a new narrative for their financial problems

  • Help the couple identify the exceptions associated with their financial problems

  • Help the couple collaborate on a new way to reframe the problem 

Correct answer: Help the couple externalize and name their financial problems

Externalization is a common narrative family therapy, and it would be helpful here, as it would encourage the clients to see the problem outside of themselves and their marriage.

You can't create a new narrative until that externalization occurs. Finding exceptions might be beneficial, but that is more of a solution-focused intervention. Attempting to reframe may come after externalization. 

33.

Marriage and family therapists typically believe all the following statements about play therapy EXCEPT:

  • Play therapy is more effective when it's directive in nature.

  • Home-based play sessions can be beneficial for observing the child in their own environment. 

  • Play is essential for a child's well-being.

  • Play therapy is correlated with positive child outcomes.

Correct answer: Play therapy is more effective when it's directive in nature.

Most play therapists subscribe to the benefits of nondirective, child-led play. 

MFTs generally agree that play is an important part of child development, that play therapy can yield positive benefits, and that it may be helpful to observe the child at home.

34.

You notice a pattern where your client, Mike, frequently interrupts his husband, Joey, during conversations. As a result, Joey tends to shut down and respond with one-word answers. Mike then becomes frustrated that Joey never "speaks his mind." 

In this process, you are MOST likely observing a type of:

  • Cascade

  • Boundary

  • Deconditioning

  • Aversive control

Correct answer: Cascade

A cascade refers to sequences that reinforce positive or negative patterns (such is the case here). In a cascade, one type of behavior by a family member leads to another type of behavior by another member, which, over time, creates a trend to the pattern. Here, interrupting Joey causes him to shut down. This then causes Mike to become frustrated, demonstrating a negative pattern and a cascade. 

If Joey told Mike to stop interrupting him, that would be an example of a boundary, which is psychological separation within a relationship.

Deconditioning occurs when a previously conditioned response is weakened or stopped by reversing the situation that created the conditioned response. 

Aversive control refers to someone criticizing or punishing someone else in an attempt to control their behavior (not the case here). Interrupting is not the same as criticizing or punishing.

35.

All the following are generally true when considering how and when infidelity might cause a crisis when working with couples, EXCEPT? 

  • One partner's disclosure of infidelity to the therapist requires breaching confidentiality.

  • Infidelity could deteriorate the relationship and significantly impact one or both partners' mental health.

  • One partner's disclosure of infidelity to the therapist requires reevaluating the treatment and goals of therapy. 

  • Infidelity could exacerbate other crisis issues like substance use or intimate partner violence. 

Correct answer: One partner's disclosure of infidelity to the therapist requires breaching confidentiality.

This is not an inherent requirement. It depends on the therapist's informed consent policy around secrets. 

It's true that infidelity could deteriorate the relationship and significantly impact one or both partners' mental health. It's true that one partner's disclosure of infidelity to the therapist requires reevaluating the treatment and goals of therapy. Finally, it's also true (and likely) that infidelity might exacerbate other crisis issues like substance use or intimate partner violence 

36.

Most of the time, Bob and Carol decide what to serve their children for dinner. Occasionally, however, they will ask their kids for input. About once a month, they rotate, allowing the kids to choose a restaurant for a family meal. 

This dynamic BEST represents:

  • Permeable boundaries

  • Diffuse boundaries

  • Rigid boundaries

  • No boundaries

Correct answer: Permeable boundaries

Permeable boundaries are relatively flexible, meaning they can change when needed (as is the case here).

A diffuse boundary often refers to a lack of boundaries or no boundaries, which isn't the case. 

Rigid boundaries rarely, if ever, make room for exceptions (so that would be Bob and Carol always deciding what their children eat for dinner).  

We see that there are still boundaries here because the children only sometimes decide what to have for dinner. So, no boundaries isn't the correct option.

37.

Allie (22) has started working with you after a bad break-up with her college boyfriend one year ago. Allie states she's been drinking more often than usual (about 4-5 times per week) and that she sometimes blacks out when she's under the influence. She indicates that she typically drinks about one bottle of wine followed by a few shots. She admits this amount has increased substantially over the past few months. She says there have been a few weeks when she stopped drinking altogether to give herself a "tolerance break." However, one night, after driving drunk, her college roommate sat her down a week ago and told her she should either go to therapy or AA because she "obviously has a problem with alcohol." Based on this information, you would MOST LIKELY diagnose Allie with:

  • Alcohol use disorder

  • Alcohol withdrawal 

  • Alcoholism

  • Nothing - there is not enough information to warrant a diagnosis. 

Correct answer: Alcohol use disorder

Allie shows enough symptoms to meet the criteria for alcohol use disorder. 

Alcohol withdrawal is a diagnosis, but we do not have any information indicating that she is in that phase right now. Alcoholism is sometimes used interchangeably with alcohol use disorder, but it is not a mental illness.

38.

Which of the following is TRUE when it comes to how therapists disclose client-related materials in research or training? 

  • Therapists need to obtain written consent from a written waiver and ensure client confidentiality.

  • Therapists cannot disclose client-related materials for those purposes.

  • Therapists need to maintain client confidentiality for these purposes. 

  • Therapists need to obtain verbal consent and ensure client confidentiality. 

Correct answer: Therapists need to obtain consent from a written waiver and ensure client confidentiality.

As part of a therapist's ethical standards, it is imperative to receive written consent (with a written waiver) and take the best steps to ensure confidentiality. 

It is not enough to obtain verbal consent. It is not enough to just maintain confidentiality. 

39.

All the following represent reasonable responsibilities a therapist might have for a client in therapy, EXCEPT:

  • The responsibility to commit to an agreed-upon length of treatment

  • The responsibility to cancel appointments in a timely manner

  • The responsibility to pay fees regularly

  • The responsibility to update personal information as needed 

Correct answer: The responsibility to commit to an agreed-upon length of treatment

A therapist would not impose this responsibility on a client, as therapists work hard to value their clients' autonomy and do not 'mandate' any length of care. 

However, it is reasonable to request that clients pay fees, cancel appointments, and update personal information (like insurance, home address) as needed. 

40.

Maria (46) comes to you because she recognizes that her house is becoming 'unlivable.' She states that her adult son and daughter will no longer visit her home because they have deemed it unsafe. During your assessment, you discover that she saves almost every receipt, piece of trash, and mail piece. She tearfully tells you that she knows rodents are in the house, but she doesn't know what to do about it. She feels embarrassed that "things have gotten this out of control." However, she states that she finds it difficult to throw things out because she's afraid she might need them at some point later. Based on this information, Maria MOST LIKELY has: 

  • Hoarding Disorder, with good or fair insight

  • Hoarding Disorder, with poor insight

  • Hoarding Disorder, with absent insight

  • N/A: Maria does not have a diagnosis based on this information

Correct answer: Hoarding Disorder, with good or fair insight

Maria meets the criteria for Hoarding Disorder. She has good insight into her hoarding disorder and recognizes that it is problematic. 

Not recognizing the problem (or not identifying it as actually problematic) would establish the specifiers of poor insight or absent insight.