California MFT Licensing Exam Questions and Answers 2023, Exams of Health psychology

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California MFT Licensing Exam

Questions and Answers 2023

A feminist critique of research into therapy outcomes would include all of the following EXCEPT: a. measures are based on male data. Discussion: Measures are based on marriage and family therapy, not only on males. According to Jellinek’s theory of Progressive Phases of Alcoholism, the phase associated with gross drinking behavior, blackouts, gulping and sneaking drinks is: a. the Prodromal Phase. Jellinek has developed a progressive model for Alcoholism: Pre-Alcoholic Phase, Prodromal Phase, Crucial Phase and Chronic Phase. The Prodromal Phase begins when the drinking is no longer social but becomes a means of psychological escape from tensions, problems, and inhibitions. Although the eventual problem drinker is still in reasonable control, their habits begin to fall into a definite pattern:

1. Gross Drinking Behavior: They begin to drink more heavily and more often than their friends. "Getting wasted" becomes a habit. When drunk, they may develop a "big shot" complex, recklessly spending money, boasting of real and imagined accomplishments, etc.
2. Blackouts: A "blackout," temporary loss of memory, is not to be confused with "passing out," or loss of consciousness. The drinker suffering from a blackout cannot remember things they said, things they did, places they visited while carousing the night before - or for longer periods. Even a social drinker can have a blackout. With prospective alcoholics, the blackouts are more frequent and develop into a pattern.
3. Gulping and Sneaking Drinks: Anxious to maintain an euphoric level, they begin to pass off drinks at parties and instead slyly gulp down extra ones when they think nobody is looking. They may also "fortify" themselves before going to a party to insure their euphoria. They feel guilty about this behavior and skittishly avoid talking about drinks or drinking. “Normal families have an evolutionary sense of time with emphasis on the process of becoming.” This statement regarding normal family functioning is descriptive of which model of family therapy? a. Experiential. This is a comment by Carl Whitaker on the concept of normality within the Experiential model. In Contextual therapy the intent of multidirectional partiality is to: C. give due consideration to each individual's interests in the various relational dimensions. At the core of Contextual therapy (Boszormenyi-Nagy & Krasner, 1986, Between Give and Take: A Clinical Guide to Contextual Therapy) is the clinical stance that therapists are accountable to everyone whose wellbeing is potentially affected by their interventions. This stance is known as multidirectional partiality and requires that therapists keep channels open to all family members and that all solutions serve the best interests of everyone. (Piercy, Sprenkle, & Wetchler, Family Therapy Sourcebook, Second Edition). Other answers can be eliminated as follows: Joining is primarily a Structural family therapy technique; Establishing a hierarchy is a hallmark of Haley-Strategic; Establishing circularity and neutrality is a Milan Systemic reference, although circularity and neutrality are not truly "established" as observed and utilized. D. establish circularity and neutrality.

Which of the following therapists emphasized the importance of transgenerational themes: d. Whitaker. Discussion: Whitaker, a psychiatrist, was trained psychodynamically and noted the importance of historical patterns and unfinished family business. Which of following statements are true of Emotionally Focused Therapy? d. Emotionally Focused Therapy is generally contraindicated in the short term for those conditions in which there is an under-control of emotion, e.g., panic disorder and impulse disorders. Emotionally Focused Therapy is contraindicated for couples where there are issues related to impulse control and domestic violence. Emotionally Focused Therapy has actually been shown to reduce Bulimic symptoms, including the frequency and severity of purging or vomiting. It has also shown a reduction in the bulimic patient's drive for thinness. The Wu family is Chinese and only speak Cantonese. The 5 yr. old daughter was having problems at school, more with behavior than language. The school having worked with Jane B. a family therapist, refers the Wu's to her, although she is unfamiliar with the Cantonese language. Which scenario is the best option? B. Jane knows a therapist who speaks Cantonese and is willing to see the family. A translator offers expediency, language and culture and, some would argue, comfort for the family and therapist. Ideally, the cross-cultural therapist wants to work without a translator. The mere fact of the addition of another person in the room makes for increased complexity. It is built-in triangulation on several levels. A same sex couple comes to therapy because they are having problems regarding parenting their ten year old son. In the course of the first interview, it is clear that each parent has very different expectations for their son's behavior. A family therapist should treat the couple: b. according to the problem being presented. Discussion : While it is a given that same sex couples should be treated the same as heterosexual couples, the focus here should be on what the family is presenting as a problem as this is why they have come to therapy. CBT family therapy techniques are least likely to be used with: c. treatment of schizophrenia. Discussion: Treatment of choice for working with schizophrenia is Psychoeducation and medication. A Milan - Systemic therapist would define the purpose of circular questioning as: D. learning more about differences in family members' perceptions of their relationships. Circular Questioning is a series of questions asked of one family member about another or about the relationships within the family. Other answers can be eliminated as follows: Disrupting the multiple interactional sequences - invariant prescription; Expanding on the notion of a reframe - positive connotation; Individualized prescription of an action - rituals

During the process of treatment, Mr. Medieros recognized how he was victimized by his parents, and that past generations were also victimized by their parents. In recognizing this he began to see his parents less as monsters and more as struggling human beings, themselves acting out invisible loyalties. Therefore, he was able to block the transgenerational pattern of destructive entitlement and allowed the positive transmission of relational resources. The process by which he earned entitlement by dealing with issues with his own parents is called: B. exoneration. Exoneration is a process by which the therapist attempts to help the client see the positive intent and intergenerational loyalty issues that motivated the behavior of members of previous generations. Regardless of how destructive their behavior may have been to the client, if others' behavior can be seen in a human (and therefore more meaningful) context, exoneration occurs, loosening the hold of the past (unjust) behavior on the client. (Piercy, et. al., p. 37) The other answers can be eliminated as follows: Societal regression is a Bowenian concept describing the level of anxiety and differentiation in the society as a whole. Relational ethics is a Contextual concept describing one element of how families function, but does not describe the resolution experience referenced in the question. Family projection process is a Bowenian concept describing the way in which anxiety is passed down between generations. What is the least likely advice a therapist would give to a man about to become a step-parent to his fiancée’s kids when he hasn't had kids before? D. Assume parenting responsibilities immediately. Note the least likely component of this question. Asserting a parenting role immediately can potentially result in conflicts around loyalty for the stepchildren. A community agency which employs an MFT as an hourly fee-for-service contractor, has designed a new treatment program for delinquent youths. The MFT is asked to be one of many clinicians delivering this new program. The program design includes a cognitive-behavioral approach adapted to family counseling. The idea came from the agency’s new clinical director who came back from a conference excited about the model. The MFT: a. …is not responsible for telling the agency what do to, but should check the available research to determine if there are any studies supporting the proposed treatment plan, and discuss his findings with the agency director. Discussion: Including a review of outcome studies is increasingly becoming expected in MFT clinical practice. The licensed MFT is expected to ensure that his own practice is consistent with all applicable guidelines, and to raise issues with an employer when a conflict with guidelines arises. It is not up to him to get the employer to comply, but it is expected that he will keep his own practice compliant. Participating in an agency treatment design that is unproven by research may be acceptable, but participating in a design that is strongly discouraged by existing research is not advisable. Systemic couple therapy with patients suffering from depression is only indicated if: b. the therapist has specialist training in systemic therapy. It is crucial that a couple’s therapist be trained systemically when working with couples.

A couple comes in for therapy. The husband complains his wife is too close to her family and she has trouble separating from them. In fact, he states that his wife is in constant contact with her mother and looks to her mother constantly to help her make decisions. Often these decisions are in opposition to decisions made previously by he and his wife. A Structural therapist in assessing this couple would: B. assess boundaries between the wife and her family. Minuchin assesses functioning of subsystems (including individuals), paying particular attention to the boundaries between them. Only "clear" boundaries support the successful functioning of subsystems, while "rigid" boundaries will prevent the exchange of needed information and affect, and "diffuse" boundaries will permit too much exchange. The other answers can be eliminated as follows: Flexibility is assessed by Strategic more than by Structural. Structural assesses couple functioning, but the answer “assess patterns of couple functioning” is very general and not as clearly a hallmark of Structural work as assessing the boundaries between the wife and her family. Differentiation is a stronger interest of the Bowen model. Children adapt most easily to remarriage if they are: A. preschoolers - either sex. The younger the child, the more easily they adapt to change according to David Schnarch. A family therapist working with a family around the acting-out 8 year old boy goes to great lengths to inform the family that he does not have a particular answer for them as to how they should proceed. This "not knowing" stance reminiscent of Goolishian and Anderson is used to help the clients: a. acknowledge their own expertise on their own lives. The not knowing stance of a Collaborative Language therapist is designed to emphasize the non-expert stance of the therapist whose role is as a co-investigator rather than an expert. This leveling of the playing field allows the client systems competence to emerge and lead the direction in collaboration with the therapist. When initially working with anorexics and their families, a Structural therapist would: D. instruct the parents to control the child's eating. In the Dare et al. (JMFT, 16:39-57, 1990) study, successful family treatment of eating disorders moved through a series of stages. Initially, primary focus was put on the eating disorder, and parents were instructed to control the child's eating. Treatment then moved to maintenance of this control in an attempt to increase body weight to within normal limits. The final phase of treatment consisted of giving control over eating and weight gain back to the child. Emphasis was also given to helping the child develop an appropriate young-adult relationship with her parents, without the use of anorectic symptoms as a means of communication (Nichols & Schwartz, 3rd edition, p. 560).

The Family Preservation Model seen in many federally-funded programs grew out of: c. the MRI model. The Family Preservation model, a model often required in many federally-funded programs is a strength-based model that dates back to the early years of social work, attempting to keep families intact. This model currently draws heavily from the Solution Focused Model's attention to building upon the strengths can already be found within families. In gathering information for an Adlerian Lifestyle Assessment of an adult female client, a therapist inquires about the client's sibling position and gathers details about the attributes of each of the client's siblings. The therapist is gathering information to assess the client's: b. Family Constellation. Rationale: A Family Constellation is about a family's make-up.A clinician gathers information about a client's ordinal position of the family and comparative characteristics of family members to better understand how a client finds belonging and meaning in current experiences.A Family Atmosphere is about a family's emotional tone and the climate of relationships that exist.Personality Priorities are patterned ways finding belonging and significance in times of stress. Early Recollections are memories retold as if they were happening in the presence.Adler believed that early memories held significance.In assessing Early Recollections, clinicians ask clients to retell a memory as if it was happening in the current moment and look for themes between the memory and current lived experience. According to research alcohol abuse is the most studied phenomenon in family therapy research. According to some outcome studies which of the following approaches have been particularly useful in dealing with substance abuse in families, especially for engaging young substance abusers? d. Psychoeducational approach. Psychoeducation has proven to be the most effective in engaging adolescent substance abusers as it is non- confrontational. The Beavers System approach to family assessment includes: A. interactional competence scales and interactional style scales. These are clinical rating scales used to measure interactional competence (normal, mid-range, highly dysfunctional families), e.g. overt power, parental coalition, closeness, clarity of expression, etc. and interactional style (centrifugal vs. centripetal families), i.e. dependency, adult conflict, social presentation, etc. A study of family therapy, rated outcomes in two different ways. The first way was a self-report in which family members were asked to rate their improvement on a scale of 1 – 5. The second rating was by trained observers watching for changes in specific behaviors on video playback of the families in their sessions. They also rated improvements on a scale of 1 – 5. Which of the following statements is correct? b. We can be more confident in the findings to the extent that the self-reports and observer ratings correlate. Discussion: It’s likely that the researchers designed this study to create greater confidence in the conclusions, by providing for two independent sources of measuring the dependent variable (family outcome). If these two are similar (correlate) we will be that much more confident in the findings. If they do not correlate, we will want to know why. Was

it a problem with the research design, or does this indicate unreliable findings? The word correlate is being used loosely here, and not in the usual context of defining the relationship between the independent and dependent variables. All of the following are considered communication theorists EXCEPT: B. White. This question requires some serious hair-splitting. All family therapists might be thought of as being "communication theorists" in one form or another. To answer the question, you must find the best answer, not necessarily the answer that is strictly "right". White's Narrative approach is a process for helping people create renewed descriptions of their lives. In contrast, the goal of the communications therapist (primarily the MRI school) is to look at the pattern of behavioral sequences that is maintained by language. This model disregards the internal structure of individuals in order to concentrate on their interaction and communication. Focus is limited to what goes on between, rather within individual, family members. White focuses on meaning whereas communication theorists focus on behavior. Communication theorists disregard the past, whereas White asks how the individual or family "story" establishes meaning in relation to the broader stories of gender, community, class, culture, etc. Mr. & Mrs. Kelly seek therapy from a behavioral family therapist because their 7 year old daughter Kristen, typically refuses to go to bed until after 10 p.m. The therapist would: b. suggest that the child be put into time out. Discussion: The options are associated with the followin models: Circular questioning (“Who in the family is most upset when Kristen does not go to bed?”), transgenerational (explore the sleeping habits of both parents when they were children) and experiential (“How does this make you both feel?”). After completing an intake with a new client family, the MFT searches a variety of resources to determine if there is research available to help guide her decision making. The family has a 16-year-old boy who has not been to school in over 3 weeks. The MFT’s search turns up a study from the American Psychologist stating that a combination of supportive therapy and anti-depressant medication has been demonstrated to be efficacious in the treatment of adolescents who are 'school refusers.' The study was a double-blind design with a sample size of 55 with a correlation of .68 and 92% confidence level. To be evidence-based, the MFT should: d. Consider this study in her decision making, document her thoughts about it, but continue to search the literature until she is confident she has found all available relevant research. Discussion: This is the best answer. The question does not clarify whether the research review was thorough. If it was not, then it must be, before the MFT can decide what studies she should consider. The study mentioned is on point, published in a mental health juried publication and appears methodologically sound. It should not be ignored, but may not be the only one to consider.

In an Adlerian parenting class that you are facilitating, a parent expresses concerns about his seven year old daughter's behavior. He reports that his daughter consistently argues with him and fails to follow even simple behavioral directives. He provided an example from the past week in which she responded with open defiance when asked to set the table. In exploring the behavior with him, you learn that he often feels challenged and threatened in these interactions. He reports that he responds by fighting back and standing his ground which often intensifies the dynamic. Using Dreikur's concept of Mistaken Goals, you suggest: b. He refrains from fighting but maintain his position by offering her limited choices such as how and when to set the table. Rationale: Dreikur's concept of mistaken goals utilizes several factors including a description of the child's behavior, a parent's feeling about that behavioral, a parent's typical reaction, and the child's subsequent response to hypothesis 'the belief behind the child's behavior' and suggest alternative responses. The information that the daughter is arguing and no following directive, that father feels challenged and threatened, and that he responds by fighting which often intensifies the dynamic all point to the Mistake Goal of misguided power. With this mistaken goal, a child's underlying belief is that I only belong or count when I am in control and have power. Therefore an encouraging response from the parent can be to give a degree of power, such as limited choices. A couple presents in crisis after the wife discovers the husband has been involved with a woman on the internet for 2 years and has come to realize that his lack of interest in their marriage may have less to do with the stress he brings home from work and his subsequent lack of interest in intimacy. A family therapist believes that there many possible ways to intervene with this couple, given their current volatility. This therapist does not seem to subscribe to the concept of: B. Equipoteniatility A family therapist is working with one member of a family who reports that when she feels vulnerable, she desperately searches for ways to numb the pain. This family member seems to be describing the role of the: a. firefighter. Classic Internal Family Systems defines the role of the firefighter as one who searches for means to numb or dull the pain of the exile. b. undifferentiated ego mass. c. parentified child. d. distractor. Under the HIPAA Privacy Rule, any therapist is liable for her/his entire practice if: d. They are a licensed, or unlicensed, mental health clinician who transmits PHI using electronic means for even one client, on one occasion. Discussion: Answer B is right, but answer D is more specific and therefore the better answer. The Privacy Rule defines 'covered entities' as any health care provider who transmits even one client's PHI electronically. While some clinicians hope to avoid the HIPAA rules by accepting only self-pay clients, thereby avoiding the need to communicate with insurance companies and thereby avoiding any computer-based billing, there are risks in this strategy. While not fully tested in the courts as of this writing, HIPAA rules might be interpreted broadly to include telephone conversations, faxes and email exchanges of included transactions. The HIPAA Privacy Rule does not differentiate between licensed or unlicensed clinicians. It states only that any health care provider would be a covered entity. An unlicensed clinician who describes her practice as something non-medical (coaching, educational counseling, job counseling) would not be a covered entity.

Mrs. S. came to therapy complaining that she has been unhappy and abnormal all her life. The therapist asked, "How do you know you are unhappy?" Mrs. S. expressed being unhappy with friendships and in her relationships with her family. The therapist then asked how Mrs. S. knew those unhappy feelings were not normal. Mrs. S. then mentioned some days in which she did feel happy. This attempt by the therapist to help Mrs. S. to identify exceptions is a technique used in: c. the Solution-focused model. Finding the exception to times when the problem occurs is a Solution-Focused technique. Biracial children have unique circumstances for identity development because: d. they may not look like their monoracial parents and therefore feel isolated from the family unit. In the early stages of identity development, children first look to their family for a sense of sameness and belonging before turning to their peers or society to formulate their identity. Monoracial parents may not realize the complexity of this process for their biracial child and therefore may be underprepared to support the child. Parents can best support their children with open conversations about race i.e. asking questions and keeping an open mind as to their child's experience of their heritage. A couple presents for treatment. The husband is of mixed Korean/Eastern European ethnicity and grew up in NYC whereas his wife, of Swedish ancestry grew up in the Midwest. The family therapist has noticed that the husband becomes overly reactive when his wife is slightly critical of him. Interestingly, the therapist has found the husband exceptionally critical in most conversations. The therapist has noted that the husband's father, a prominent heart surgeon was often emotionally abusive when the husband was a child. This therapist is beginning to identify the: b. negative introject. This Object Relations therapist has begun to identify the negative introject that the husband has disowned and projected onto his wife. The therapist would work to help the husband own this part of himself (his critical self) re-integrating his negative and positive introjects. A therapist instructs a family to comment on the teams comments about their family process after after the team spends time discussing among themselves what they have just observed over the first 10 minutes of a family session. The therapist is using a: C. Narrative approach. This is an example of Tom Anderson's use of a reflecting team. The basic process is for the interviewing therapist to engage in a conversation with the family, while the rest of the team quietly observes and then ask the family to observe while the team discusses what they saw. The phrase "questions about questions" suggests one of the Constructivist approaches (Narrative being a Constructive approach), which focus on how language constructs a view of reality, and therefore how deconstruction of reality can be achieved through questioning the use of language.

A family therapist is working with a family with a large extended family. Boundaries have been very diffuse between the family and some of the younger cousins. The therapist tells a story about her own family, specifically noting a time during adolescence when a cousin dropped by unannounced and how it threw the family into a small crisis. This therapist is most likely working from: d. Collaborative This therapist is operating from the stance of the Collaborative model where the therapist is much more comfortable offering a degree of transparency. A real life experience highlighting a similar experience she has had in her life is told in order to support the client system. Also important in this question is to note the stance of the therapist; s/he is a co- explorer and offers a perspective, not an answer or solution. Also note the trick use of the word diffuse to lead you astray and move you closer to the Structural model. A client reports, " When I feel vulnerable, I find myself grasping for ways to dull the degree to which I feel pain. All I care about is not feeling the pain!" This client might be describing the role of the A. firefighter. The Internal Family Systems model sees the nature of the mind is to be subdivided into an indeterminant number of sub- personalities or "parts." The firefighter is the part that attempts to numb pain through behaviors that are often addictive in nature. Beth and Paul come to counseling because Beth feels that after two years of marriage she and Paul have nothing in common. She said that for the past six months she has been complaining to Paul that there are problems with their relationship. Paul states that he doesn’t think there are problems; he feels his wife is just overreacting. Which therapeutic model would directly confront Paul's pathologizing of Beth as problematic? b. Feminist model Feminist Family Therapists challenge traditional family roles by questioning gender roles and their stereotyping and how these have affected the family. Pathologizing the female experience, as in the usual model of codependency, is emphasized as problematic. Feminists work to move blame from an individual person to one's socialization process with special emphasis on the validation of the female experience (Bepko & Krestan, 1985). The other models are less likely to directly confront pathologizing.

Structural and MRI Strategic differ in their orientation to all of the following EXCEPT: C. emphasis on process over content. This is an "exception" question. We are looking for the exception to differences, so, we are looking for similarities. Structural and MRI are similar in their emphasis on process over content. Therefore that is the best answer. Other answers can be eliminated as follows: Feedback Loops - Structural and MRI Strategic therapies differ regarding how they conceptualize the role of feedback loops in maintaining symptoms. In Structural Family Therapy (and in Haley-Madanes Strategic Therapy) dysfunction is seen in terms of rigid, homeostatic transactions that must be broken. Drawing from General Systems Theory, a family's response that resists change (rigid transactions) is defined as "negative feedback", as opposed to "positive feedback" which is thought of as deviation amplifying. Therefore, an attempt to maintain the family's status quo (e.g., a daughter's asthma keeps the mother and father together) is conceptualized by Structural therapists as negative feedback. In contrast, MRI's version of Strategic family therapy conceptualizes family dysfunction in terms of positive feedback, or the vicious cycle created when an attempt to solve a problem (e.g., a wife's nagging) inadvertently worsens the symptomatic behavior (e.g., her husband's drinking). The "positive feedback" given to the system in an attempt to induce change, inadvertently interferes with that change. The MRI therapist's view of family problems arising from positive feedback necessitates a therapeutic focus on the behavioral sequence as the locus of analysis and the target for change (e.g., "What can you do now that will make a difference?). Haley-Madanes' Strategic therapy, with its assumption of a rigid, negative-loop, attempts to alter those sequences that maintain the homeostatic family structure. Structural Family Therapy attempts to alter the family's organization (structural homeostasis). Punctuation of Sequences - Sequences are punctuated differently by these two approaches. Colapinto (1991) best describes the theoretical difference between Structural and Strategic therapies through his discussion of the differences between "complementarity" (a Structural term) and "circular causality" (a Strategic concept). Circular causality designates a sequential two-way interaction (A.'s behavior causes B.'s behavior, and vice versa), represented by arrowed lines connecting A and B. Complementarity on the other hand, designates a spatial configuration (A's and B's shapes fit), represented by the interlocking pieces of the puzzle. This semantic difference is not trivial, but is consistent with the Structural therapist's preference for tracking spatial arrangements (literal and metaphorical) among family members, rather than sequences of behavior. (Piercy, et. al. pp. 54-55). Therapist Use of Confrontation: The differences in therapeutic interventions (including confrontation) between the two approaches are not always clear-cut but are more a matter of emphasis. For example, Structural Family Therapy is typically more confrontational than Strategic, perhaps because of Minuchin's own personal style. Although both are present-oriented, Structural Family Therapy focuses more on in-session behaviors and is more likely to employ in-session enactments. Strategic therapy, on the other hand, generally explores current out-of-session behavioral sequences and employs directives to be completed outside the session to disrupt these sequences (Piercy, et. al. p. 55). The goal of Emotionally Focused Therapy is: a. To create a shift in partner’s interactional positions and initiate new cycles of interaction. b. All of the above. Emotionally Focused Therapy works to re-organize primary and secondary emotions through the creation of a strong attachment (trust) bond between partners. Once achieved, new interactional patterns are developed based on the more secure bond. c. To foster the creation of a secure bond between partners. d. To expand and re-organize key emotional responses – the music of the attachment dance.

The Jones family is an African American family referred to Mrs. B., a Caucasian family therapist. In working with this family, Mrs. B. should be aware of which of the following? A. One of the issues that has led to the resistance of African American families toward mental health services has come from confusion about the relationship between mental health clinics and other agencies. B. For many African American families the idea of going for treatment is a very new one, and often the questions asked by therapist can be perceived as intrusive. C. All answers provided. Discussion: A key to understanding families of any ethnic origin is to learn how the family perceives mental health and social service agencies. The familial boundary of African-American families has developed from a kinship model which utilizes the larger family system as its support, rather than social service agencies. African-American families can often appear cautious or guarded when dealing with a social service agency seen as being part of the majority culture. It is often important to clarify exactly what is the scope your involvement with the family system and how clinical work is separate from other social service agencies. D. The type of resistance and suspicion often manifested by African American families should not be summarily categorized as a contraindication for successful treatment. Haley believed that normal family functioning includes all of the following EXCEPT: b. connectedness. Discussion: Haley’s Strategic Model emphasizes problem-solving. Haley is not looking for family members to feel closer, or more connected, but to solve the presenting problem and re-establish the parental hierarchy. Family therapy would probably be the primary intervention choice for all of the following EXCEPT: b. Borderline personality issues. Characterological disorders such as Borderline Personality Disorder require long-term individual treatment, hence is the best answer for this question. Maturano speaks of systems that can be controlled from the outside, similar to machines, as being: a. Allopoietic Systems Allopoietic systems are controlled from outside of the system.

An MFT retired to a rural area. She decided to volunteer for the local community mental health agency to do some home-based family therapy. Her work was entirely free, not receiving any compensation from the agency or from the clients. After a few months working with one particular family, the father mentioned that he often drove past her farm and noticed her barn door didn't close and was off its hinges. He stated that he would be happy to fix it for her, since she had done so much for his family. The correct statement about her obligation under HIPAA rules is: c. She is a 'covered entity' unless she is separated from the agency as totally independent, has no access to other agency clients' PHI, and does not transmit any PHI electronically. Her obligation under HIPAA would be the same as her agency's, if she were an employee, or had access to other client's PHI. If she has a private, solo practice and does not transmit any PHI electronically, she is not a covered entity. If she is providing services under her license as a mental health professional, she is still bound by the state-specific ethics and confidentiality regulations. HIPAA Security rules do not apply when the clinician is not a 'covered entity' under the Privacy Rules. HIPAA definition of a 'covered entity' does not differentiate between paid and voluntary health care providers. Jose and Maria bring their son Joe to counseling because of poor academic performance and behavior. A Strategic therapist would: A. coach the family on improving its problem-solving skills. The Strategic family therapist defines the focus of treatment as the family and its interactive process, paying particular attention to the family's process of problem solving. Other answers can be eliminated as follows: Rearranging family members - Structural; Using a genogram - Constructivist/Transgenerational/Bowenian; Externalizing the problem - Narrative. After 9/11, the US responded to the attack with the invasion of both Afghanistan and Iraq. A systemic concept that addresses this knee jerk approach to solving a problem (9/11 attack) by offering a solution focused only on the symptom rather than the root cause of a much bigger issue in the world (effects of US colonialism) is: d. societal regression. Bowen looked beyond families into society and felt at times larger social issues in society were often given "Band-Aid solutions" which missed the core systemic structures that had resulted in the problem, coining the concept of societal regression. A couple comes in for therapy. The husband complains his wife is too close to her family and she has trouble separating from them. In fact, he states that his wife is in constant contact with her mother and looks to her mother constantly to help her make decisions. Often these decisions are in opposition to decisions made previously by the husband and his wife. Which of the following questions would a Bowenian therapist ask the husband? C. "What was your mother's relationship with her mother and family?" Bowen hypothesized an orderly and predictable process connecting the functioning of family members across generations. The other answers can be eliminated as follows: "What effect does your wife's closeness have on your relationship?" - Narrative; "How many times per day does your wife contact her family?" - Behavioral; "How have you tried to solve this problem in the past?" - Solution-Focused.

Which model is most closely affiliated with brief therapy? b. strategic. Discussion: In 1967 the Brief Therapy Center of MRI opened under the directorship of Richard Fisch. The staff included John Weakland, Paul Watzlawick, and Arthur Bodin. Their mission was to develop the briefest possible treatment for psychiatric disorders. What emerged was an active approach, focused on the presenting symptoms, and limited to ten sessions. (Nichols and Schwarz, 4th edition) All of the following are examples of physiologically-based sexual dysfunction except: B. hypoactive sexual desire. Hypoactive or inhibited sexual desire is a sexual disorder that refers to an individual's arousal capabilities, rather than physiological responses. The other sexual dysfunctions are based upon known physiological phenomena that can prevent a person from functioning sexually. While these problems may also have a psychological basis, they are known to be physiologically- based as well. When a therapist decides to close his/her practice and the client wishes to continue with treatment the therapist should provide at least referrals. b. Three When closing a practice a therapist must follow state and federal laws governing closing a practice and the maintaining of records. In general, a therapist should provide 3 referrals.

PRACTICE TEST 2

A mother calls the therapist sounding very panicky, wanting an immediate appointment. At the first session, the mother states that her 12 - year old son Sam has just been caught in the bathroom of a neighbor’s home with a 6 - year old boy. The 6-year old says that Sam was playing with his “bum” and kissing his penis. When confronted by his mother, Sam admitted to having “played” with the boy on 4 previous occasions. The neighbor boy’s parents have banned Sam from their home and informed other parents and the school about his “perversion”. Sam’s mother called a psychiatrist prior to calling you who she says stated, “You can put him into therapy and give him drugs, but it’s probably already too late.” You begin seeing Sam and his family. In your first meeting with this family, you begin by speaking for a time with each member of the family, asking them about themselves. This engagement technique might be used in which school of family therapy? C. Strategic / Haley. This is an example of how Haley conducts his Structured Initial Interview as explained in his book, Problem Solving Therapy Theory. The role of a Strategic therapist is: c. conducting a structured initial interview. Whose clinical model uses the following terms: placater, blamer, avoider? D. Communication - Satir Although Satir, Watzlawick and Haley are all associated with communication theory, Satir is the one who uses the terms placater, blamer, avoider (also leveler and computer). White is not associated with communication theory, he is associated with a Narrative approach. A family comes to therapy because their ten year old child is stealing money from them. After three sessions, the stealing stops and the family decides to terminate therapy. A Collaborative therapist would: A. maintain input from all members of the system, including him/her self and mutually determine if therapy should end. In Collaborative therapy, frequency, duration, and termination of sessions are determined and negotiated on a session- by-session basis with input from all members of the family and therapy team. LoPiccolo is a well-known sex therapist who helped developed: B. a sexual growth program for women who have problems in experiencing orgasm. To answer this question you have to be familiar with LoPiccolo's and others' work in sex therapy. Heiman, J., LoPiccolo, L., & LoPiccolo, J., (1988) wrote a book titled, "Becoming Orgasmic: A Sexual Growth Program for Women". The other answers can be eliminated as follows: Helen Singer Kaplan developed the triphasic model of sexual response: desire, excitement, orgasm which offers a differential diagnosis of psychogenic and organic etiology. Kaplan wrote "The Evaluation of Sexual Disorders: Psychological and Medical Aspects". This book focuses on the diagnosis and evaluation of sexual disorders, with a special emphasis on the differential diagnosis of psychogenic and organic etiology. In the first

section, Kaplan describes her general process of psychosexual evaluation of dysfunctional patients. In the second section, a group of colleagues detail the medical evaluation of the major dysfunctions. In the final section, Kaplan details her specific assessment criteria (both medical and social-psychological) for gender identity disorders, the major psychosexual dysfunctions, sexual phobias and avoidance, and unconsummated marriage. Kaplan wrote another book titled, "The Sexual Desire Disorders: Dysfunctional Regulation of Sexual Motivation" in which she integrates theory, research, and clinical skills to provide an excellent resource for evaluating and treating desire disorders. (Piercy & Sprenkle, pp. 174). Research has shown that a successful predictor to a positive outcome utilizing Emotionally Focused Therapy is: a. how well established the therapeutic alliance is, especially the task aspects of engagement. Key to successful predictors of outcome when using Emotionally Focused Therapy with a couple is how well the therapist is engaged with each member of the couple system. It is from the foundation built between the Emotionally Focused Therapy therapist and the couple that a deeper emotional experience will ultimately be trusted. This approach represents a multidimensional, theoretical model for the understanding of relationships in which men are violent toward women and argues that abusive relationships exemplify, in extremes, the stereotypical gender arrangements that structure intimacy between men and women generally; and proposes that paradoxical gender injunctions create insoluble relationship dilemmas that can explode in violence. This multifaceted approach to treatment, which incorporates feminist and systemic ideas and techniques was designed by: B. Goldner, Penn, Sheinberg & Walker As part of the Ackerman Institute and more specifically as members of the Women's Project, Goldner et al. wrote an article entitled, “Love & Violence: Gender Paradoxes in Volatile Attachments”. This question speaks to some of their findings. Clinicians looking for guidance from outcome research want to know if the model being tested works in real-world clinical settings. To respond better to this concern, the most important next step researchers should take is: d. Include clients with dual morbidity in their studies. Discussion: Most research does already use clinicians in the research design phase. Some of the strongest critiques of MFT outcome research are that research can be too dominated by clinicians who are trained in the model being tested, and therefore are biased in favor of it. Research should be objective and neutral with respect to outcomes, so that we can form conclusions about it based on the most reliable findings possible. Mary is a 15 - year-old who has been truant for 31 days. In addition, her parents report that Mary sleeps all day and stays up most of the night. She has gained 30 pounds over the past six months and she looks sad. Mary has isolated herself from all her friends. These symptoms best describe: D. Persistent Depressive Disorder. Persistent Depressive Disorder is the current DSM- 5 category depression or depressive neurosis which was called Dysthymia in DSM-IV TR. Bowen was concerned with all of the following EXCEPT:

C.

content. This is an exception question. Find the answer that does not fit well with Bowen therapy. As with most of the early systems-oriented family therapists, Bowen was more concerned with process than content and believed that each family member reacted and contributed to the family's chronic anxiety. Which of the following statements are true? a. For boys whose parents divorce, the risk of dying from accidents and violence was particularly robust, as they grew up to be more reckless. b. The experience of parental divorce was strongly linked to earlier mortality from all causes, including accidents, cancers, and cardiovascular disease. c. Children’s standards of living decreased, on average, when their parents divorced, but the psychological effects went beyond the economic changes. d. All of the above. See: The Longevity Project Drs. Howard S. Friedman and Leslie R. Martin http://www.howardsfriedman.com/longevityproject This is an 8 decade study ended in 2011 and concluded that divorce is much more traumatic to children than the death of a parent. In assessing a couple which of the following family therapists would use an approach that includes:(1) Probing for stream-of-consciousness and visual images each spouse has when describing past marital events that did (or presently do) elicit negative affect and (2) Using a series of questions of the form "and if that were true, then what would the implications be?" to identify the "bottom line" most upsetting meanings the person attaches to the event? A. a Cognitive-behavioral therapist. The Cognitive Behavioral approach looks at the meanings attached to behavior. Object Relations looks for repressed affect, Experiential brings to the open current affect, and Contextual looks at intergenerational fairness. Known for his work with alcoholic systems, David Treadway suggests that a common coping mechanism for children in such systems is that of adopting certain rigid roles such as: A. scapegoat, hero and lost child. Treadway has posited that children who grow up in alcoholic systems need various survival skills in order to cope with the unpredictability of these systems. Rigid roles such as hero, scapegoat and lost child may get children through such craziness, but do so with a toll in later life. Pleaser, placater, etc., is from the work of Virginia Satir. Mover, opposer, etc., is from Kantor and Lehr. SG, Chapter 26. key: Treadway, substance abuse, alcoholic systems, roles The Solution Focused therapist believes that solutions to problems are often:

a. Unrelated to the way the problems developed. Hence, the non-historic stance of the Solution Focused therapist who does not need to know what the problem is, let alone its etiology. Co-therapists serve a variety of functions in family systems therapy as does the use of teams. Use of co-therapy is an important component of which of the following MFT models? A. Experiential, Milan Systemic and Internal Family Systems Whitaker is known for his use of co-therapist to help contain his "craziness". The Milan group utilized a male female co- therapy team to generate neutrality and Internal family systems views the client's Self as co-therapist and trusts the wisdom of the internal system. Co-therapists serve a variety of functions in family systems therapy as does the use of teams. Use of co-therapy is an important component of which of the following MFT models? d. Experiential, Milan Systemic. Co-therapy is used by Whitaker and the Milan Group. Whitaker uses the co-therapist to provide a holding tank for him as he goes off into his own symbolic expression, while the Milan Group uses the co-therapist to adjust for gender neutrality. David Olson’s Family Circumplex Model maps the dynamic relationships within families; identifying the following dimensions as critical to show how all family members and their behaviors are interconnected. Which of the following are Olson’s dimensions? C. Cohesion, Flexibility and Communication Olson's Circumplex model maps these dimensions. In Adlerian parenting models, it is important for parents to pay attention to and monitor their own emotional reactions because: c. They can use their emotional reaction to better understand their children's mistaken goals. In the course of an initial interview with a divorced mother, her two daughters and a son, you realize that you are also treating the gay ex-husband/father. As the therapist, you should: c. further assess the context of the referal. A family therapist is referred a new family whose cultural background is one that she has no experience working with. As she begins to explore the ethnicity of this family, her attention should be on all of the following except

a. gender roles. This is a bit of a tricky question. Ethnicity is a broad, non-gendered term that applies to all people. It relates to a person's ethnic heritage. Hence, when exploring a family system's ethnicity, a therapist would not address gender roles (which while important in terms of the family structure) would not be addressed from the broad lens of ethnicity. That is not to say, however, that gender roles do not have cultural influences which would include gender roles. Therefore, the best answer here is gender roles. Mr. & Mrs. Doherty present for family therapy complaining that their son Jon will not listen to them and is acting out. In implementing a treatment plan, a Strategic therapist would: b. track disabling sequences. Strategic family therapists define the focus of treatment as the family and its interactive process, of which the "disabling sequence" is an important element. The symptom is seen as an individual's part of a disabling sequence. The other answers can be eliminated as follows: "Cutoff" is a reference to Bowenian therapy, but we do not "re-establish" a cutoff. We would prefer to eliminate the need for emotional cutoff which is seen as a dysfunctional response to high anxiety and lack of differentiation. Establishing a clear boundary: Structural. Hypothesizing about epistemology: Milan Systemic. After completing an intake with a new client family, the MFT searches a variety of resources to determine if there is research available to help guide her decision making. The family has a 16 year old boy who has not been to school in over 3 weeks. The MFT’s search turns up a study from the American Psychologist stating that a combination of supportive therapy and anti-depressant medication has been demonstrated to be efficacious in the treatment of adolescents who are 'school refusers.' The study was a double blind design with a sample size of 55 with a correlation of. 68 and 92% confidence level. To be evidence-based, the MFT should: b. Consider this study in her decision making, document her thoughts about it, but continue to search the literature until she is confident she has found all available relevant research. Discussion: This is the best answer. The question does not clarify whether the research review was thorough. If it was not, then it must be, before the MFT can decide what studies she should consider. The study mentioned is on point, published in a mental health juried publication and appears methodologically sound. It should not be ignored, but may not be the only one to consider. According to Contextual Family Therapists, the four important dimensions of a family are: B. facts, individual psychology, family or systemic interactions, relational ethics. Answers “trustworthiness, ledger, merit, and multidirectional partiality” & “destructive entitlement, personal interests, revolving slate, facts” include key concepts of the Contextual treatment model, not dimensions of family functioning, while “justice, balance between give and take, trustworthiness, horizontal and vertical relationships” are dimension of the Contextual model's relational ethics. Notice that it was not enough to find just any concepts related to the Contextual model. The question specified "dimensions of family". Contextual dimensions or concepts about assessment or treatment would not be correct answers. Questions are a fundamental tool used by all therapists. When a Solution Focused therapist, working with a client presenting with issues around overeating, asks "What would you not want to change regarding the way you eat?", they are beginning to negotiate the:

b. first-formular task. Which school of thought has recently emerged placing a renewed emphasis on language and meaning, rather than a strict adherence to the more common theories of family therapy? This school of thought is more pluralistic, crossing disciplinary boundaries while breaking free of old paradigms. It views the therapist as part of the therapy process, rather than as an expert. A. Postmodernism Postmodernism emphasizes language and meaning, placing the therapist inside the therapeutic focal unit. ref: Study Guide, p. 13 A Saudi family who has been in the US for 7 years comes to your office for an initial session. They have come to family therapy because their eldest son who is 15 has become defiant, speaking back to both parents and was recently caught cutting school. The father and mother are at odds around how to deal with the son. The mother states that this is normal for boys in the US to behave this way while the father wants impose much more stringent discipline and supervision of the boy, restricting him to the house when he is not in school. c. working towards strengthening parental subsystem so that they might parent as a more unified front. This question initially presents with ethnicity and acculturation related issues, yet as you read on it is clear that the parents are not on the same page regarding how to deal with their son. A family therapist must always take into account a family's ethnicity and how this influences family structure, yet it is clear that the best answer related to the therapy's initial goal is work on unifying the parents so that they can work together to come up with a means to approach their son. Joining with either parent will only further the split and a psycho-ed approach at explaining adolescent development while helpful would not be the first goal of the therapy. Susan, a 31 yr. old, African-American woman has begun therapy for the first time. Her therapist has explained to her how how important it is for her to come on a weekly basis, that this sort of continuity and regular meeting times is important to her feeling comfortable in therapy, allowing her to develop a sense of trust and safety so that she can express her most private thoughts without fear of consequence. This is an example of the therapist: b. Setting the Frame Setting the frame sets the tone of the therapy,offering the promise to a client that the therapy will be conducted in a secure and consistent environment inwhich highly sensitive private feelings and fantasies can be expressed and explored without threat of actualizing the feared consequences. This could further be understood as reaching a level of engagement that allows the client to trust the therapist at a high level. Internal Family Systems believes all of the following EXCEPT: D.

Communication theory can be applied to the internal system and with the ultimate goal of a "parts party" as a means of integrating the four parts. This is not a tenant of Internal Family Systems; the notion of a parts party comes from Satir's work. In brief prescriptive therapy, termination is: C. initiated when the agreed upon number of sessions is up. This question references a generic brief therapy model. Generally, in this brief prescriptive therapy model, termination is initiated by the therapist when there is a change in the presenting problem or when the agreed-upon number of sessions is up. With compliant families, Strategic therapists acknowledge progress and give the family credit for success; with defiant families, they express skepticism and predict a relapse (Nichols & Schwartz, 3rd edition, pp. 511) A family comes to therapy because their son has just been diagnosed as schizophrenic. The parents report that the hospital report alluded to the fact that their son’s schizophrenia was caused by the family’s dysfunction. The therapist states that schizophrenia is genetically based, and that the family had “no control over it”. This therapist is MOST LIKELY coming from which model? d. Psychoeducational. Discussion: The psychoeducational model was born of dissatisfaction with both traditional family therapy and psychiatric approaches to schizophrenia. Carol Anderson, Douglas Reiss, and Gerald Hogarty focused on the devastating impact of schizophrenia on family systems, rather than on the possible effects of pre-existing family characteristics on either the onset or maintenance of the syndrome. In an Adlerian parenting class that you are facilitating a parent expresses concerns about his seven year old daughter's behavior. He reports that his daughter consistently argues with him and fails to follow even simple behavioral directives. He provided an example from the past week in which she responded with open defiance when asking to set the table. In exploring the behavior with him, you learned that he often feels challenged and threatened in these interactions. He reports that he responds by fighting back and standing his ground which often intensifies the dynamic. Using Dreikur's concept of Mistaken Goals, you suggest: d. He refrains from fighting but maintain his position by offering her limited choices such as how and when to set the table. a. Dreikur's concept of mistaken goals utilizes several factors including a description of the child's behavior, a parent's feeling about that behavioral, a parent's typical reaction, and the child's subsequent response to hypothesis 'the belief behind the child's behavior' and suggest alternative responses. The information that the daughter is arguing and no following directive, that father feels challenged and threatened, and that he responds by fighting which often intensifies the dynamic all point to the Mistake Goal of misguided power. With this mistaken goal, a child's underlying belief is that I only belong or count when I am in control and have power. Therefore an encouraging response from the parent can be to give a degree of power, such as limited choices. A mother calls the therapist sounding very panicky, wanting an immediate appointment. At the first session, the mother states that her 12 - year old son Sam has just been caught in the bathroom of a neighbor’s home with a 6 - year old boy. The 6 - year old says that Sam was playing with his “bum” and kissing his penis. When confronted by his mother, Sam

admitted to having “played” with the boy on 4 previous occasions. The neighbor boy’s parents have banned Sam from their home and informed other parents and the school about his “perversion”. Sam’s mother called a psychiatrist prior to calling you who she says stated, “You can put him into therapy and give him drugs, but it’s probably already too late.” You begin seeing Sam and his family. From a Milan Systemic approach you would: B. inquire about the family processes that preceded and followed the incident, as you maintain a neutral posture. Inquiring about the family processes infers neutrality, hypothesizing and circularity, all of which are hallmarks of Milan Systemic therapy. Realigning the hierarchy is a Haley - Strategic approach. Invisible loyalties come from Nagy’s model, and interest in affect would be most closely connected to Experiential therapists. The husband says that he is angry at his wife. The therapist says, “Look at your wife and tell her why you are angry?” What technique would the therapist be using? c. enactment. Discussion: Joining and accommodating are structural techniques, but enactment is the technique in which the therapist encourages the acting out of dysfunctional transactional patterns. Through setting up these transactions in the present, the therapist learns much about the family’s structure and interactional patterns. A family therapist has in-session goals to accentuate the client's expression of attachment needs. Such emotional expression might be termed: b. Primary Emotions. This question is a good example of how a generalized notion of a family therapist actually refers to a model; in this case, Emotionally Focused Therapy. You are being tested on your knowledge that attachment needs are the basis of primary emotions. The Contextual model regards which of the following dimensions as the most essential and powerful in family relations? D. Relational ethics The relational ethics dimension emphasizes the subjective balance of justice and determines relational trustworthiness, regarded as being the most essential and powerful in the family. All answers are relevant to Contextual family therapy. Relational ethics is the best answer. Sex therapy with a couple would end when: d. Client's goals are completed. Discussion: This question is actually a bit trickier than it looks. While most sex therapy is behavioral, one has to include David Schnarch’s model here as well. So while this is not completely accurate as this is not how Schnarch’s Passionate Marriage model works, behavioral sex therapy would end when the client’s behavioral goal have been met. Hence it is the best answer. What is the purpose of licensure for Marriage and Family Therapists? d. to create third party eligibility.

Discussion: Not all states that have licensure have third party eligibility (vendership). While generating revenue, it is not the primary purpose of licensure. Licensure does impose a standard of training on those identifying themselves as MFT’s, though not to exclude other disciplines. A family consisting of a lesbian couple and a 9 yr. old son who has been school refusing for the past year has asked for family therapy. In the first session, you notice that whenever the son speaks, one of his mothers is quick to finish his sentence. You adjust your chair as therapist to block the mother and her attempt to speak for her son. You do this in order to address which of the following Bowenian concepts: a. fusion. This is an example of the mother and son being fused to the extent mother is finishing his sentences. Note the structural technique of blocking used to confound you in your thinking. Undifferentiated ego mass, is a related concept and might be used if fusion was not included. A client was unhappy when he discovered that his therapist had disclosed his town of residence to a colleague during a peer supervision meeting. The meeting included an administrative assistant who was not a licensed mental health professional and lived in the same town as the client. The therapist's response to the client was to engage him in a conversation about his concerns and then proposed a clinical hypothesis suggesting the client was excessively fearful. The client did not accept this, and instead insisted that he did not want this kind of information disclosed to anybody without his written authorization. He claimed the therapist had violated his confidentiality under the HIPAA policies given to him at the beginning of his treatment. Referring to the above vignette, in this situation: d. The therapist's disclosure is allowed if he can demonstrate that it falls under the guidelines of 'Permitted Disclosures' clause of the Privacy Rule. Discussion: All disclosures of PHI are not prohibited under the Privacy Rule and also not always prohibited in most state- specific confidentiality rules. Also, it is not always necessary to obtain a written authorization to release information, so long as the therapist provided a thorough and accurate disclosure of how he handles PHI at the onset of therapy. The 'Permitted Uses and Disclosures' clause of the Privacy Rule allows the therapist to use his own judgment in disclosing identifying information if it is either a normal or necessary part of 'treatment, payment or health care operations'. In this case, the therapist would have to demonstrate that there was a need to disclose the client's town of residence as part of the peer supervision discussion. Some acceptable purposes would be if the peer group used town of residence to differentiate this particular client from another (thereby avoiding even greater identification that would occur names were used), or if the peer group were assisting with insurance billing and the forms were being completed in the meeting. However, the principle of 'minimum disclosure' stipulates clinicians should not disclose names or residence in supervision unless there is a good reason to do so, and then the reason should be documented. If the disclosure were casual and not for a good treatment or health care operations reason, then the disclosure is not allowed under the Privacy Rule without written authorization. If the clinician was not a 'covered entity' according to the Privacy Rule, then HIPAA guidelines would not apply, and the state-specific confidentiality statutes would determine the legitimacy of the disclosure. Where conflicts occur between state specific guidelines and HIPAA rules, the HIPAA principle of 'preemption' states that the federal guidelines will override state guidelines except in certain specific circumstances, such as mandatory reporting requirements in state licensing laws. Actions of the therapist aimed directly at relating to family members or the family system are commonly known as: B. joining.

Accommodation is used when the emphasis is on the therapist's adjustments of himself in order to achieve joining; maintenance operations often involve the active confirmation and support of family subsystems; circular questions are interview questions used to learn more about changes and differences in family relationships which might provide clues to recursive family patterns. Feminist family therapists are critical of the cybernetic concept of circular causality in male-female relationships because of the implication of: C. equal power and control. Wynne labeled the strangely unreal qualities of both positive and negative emotions of disturbed families pseudomutuality and pseudohostility, and the nature of the boundaries around them as: d. rubber fences. Discussion: Wynne’s studies of schizophrenic families began in 1954 when he started seeing the parents of his hospitalized patients. He was fascinated by the chaos he observed in these families and sought to make sense out of it by extending psychoanalytic concepts and role theory to the systems level. The term rubber fences describes the boundaries of disturbed families as apparently yielding, but actually impervious to outside influence (especially from therapists). Multiethnic and multiracial families often present with rich and complex histories and dynamics.The best assessment tool for outlining the complexities of a multiracial family is a: d. cultural genogram. A genogram is useful for increasing understanding of family relationships and dynamics. Further identifying and exploring the multiracial heritages across the family generations can provide insight into isolation, bonds, beliefs, roles and societal micro aggressions. Studies involving family therapy vs. individual therapy in the treatment of anorexia nervosa have suggested: d. family therapy was more effective than individual therapy.

In a well designed study (Dare et. al, 1990; Russell et al., 1987; Szmukler, Eisler, Russell, & Dare 1985), investigators compared Structural and Strategic family treatment with an individual supportive treatment of anorectics and bulimics. Eighty female patients were randomly assigned to either family or individual therapy immediately following an inpatient hospitalization. The outpatient treatments were continued for one year after discharge from the hospital. The findings suggested that family therapy is generally more effective than individual therapy when age of onset of the illness is less than 18 years. On the other hand, investigators found suggestive evidence that individual supportive therapy is more effective than family therapy when the age of onset is more than 18 years. These results held on the criteria of dropping out of treatment, weight gain and general ratings of outcome. No significant differences were found in recidivism rates. Knowledge Domain: 16. Research & Outcome Studies of MFT Type of Question: Straight Practice Domain: 3. Conducting Course of Treatment Glossary Keywords: Anorexia Nervosa, Structural Family Therapy Originated by postmodern Chilean biologist, Maturana, systems that are self-organizing and self-maintaining, such as biological and human systems. Autopoietic Systems can be described by: a. 2nd order cybernetics. This is a classic definition for an an autopoietic system which can often be described by second order cybernetics. A therapist reports to her supervisor that a family she is seeing complains to her that she doesn't listen well to what they tell her. Her supervisor responds, "I'm sorry, what were you saying?" This is an example of: d. isomorphism. Isomorphism is a structure or pattern that repeats itself from one level of a system to another. The ‘not listening' structure repeats from the level of therapist-client system to the level of supervisor-therapist system. Greg argued with his parents about his curfew so his parents grounded him. Greg then ran away and stayed with a friend. A first-order intervention at this point might be: A. to help the parents find a more effective punishment to tame this out-of-control child. First-order change involves change in which the fundamental rules of the system remain the same. In the above example, the rule is maintained: if you break curfew, you will have a consequence. The other answers can be eliminated as follows: “to explain that this is a developmental crisis and negotiation is in order” - the therapist is dealing with life cycle issues and tasks, thereby seeing Greg's behavior in the context of necessary changes in the family. This is a "rule" change; arguing can have a positive purpose and should be understood and learned from, not necessarily punished. “To help Greg and his parents understand and rewrite the story of moving on” - A Narrative approach - externalization of the problem, again changing the "rule" from consequences to understanding and learning as a family. “To have the parents act preoccupied and sad around Greg and imply they have given up trying to control him” - typical MRI second-order change; a change in the rules governing their response, thereby changing the meaning of a problem-maintaining interactional sequence. The hope is that this shifts Greg from feeling trapped by his parents to feeling concerned about them, and he becomes more reasonable. Parents learn when attempted solutions aren't working, try something different. This changes the way Greg and his parents interact. An MFT has been seeing a divorced father with two daughters, 8 and 12 years old. After not showing up for an appointment, the MFT receives a call from the police stating that the mother reported the children and the father as

missing and that he is the primary suspect in the childrens' disappearance. The police demanded copies of his psychotherapy notes to see if there's anything in them that will help determine the childrens' location. In this situation: c. The MFT should hand over his psychotherapy notes so that the police can determine if there's anything of value to them in the notes. Discussion: HIPAA Privacy Rule states specifically that PHI and 'psychotherapy notes' disclosures are required for legitimate public health and safety reasons. Further Discussion: Answer A. By virtue of being licensed by his state as an MFT, the clinician has accepted an obligation to cooperate with law enforcement under a number of circumstances. HIPAA disclosure requirements are specific about this, even if one's state confidentiality laws are vague. Answer B: The state's mandatory reporting laws might, or might not apply. If, for example, the father had made specific threats in therapy about kidnapping the children, most state reporting laws would assert a 'duty to warn'. But this is not the primary reason why the MFT must cooperate with the police, and cooperation is required by HIPAA even if 'duty to warn' were not triggered. Answer D: As a Federal law, HIPAA specifically preempts state law where state law is contrary. Exceptions, in which state law would prevail, include situations where the state law is stronger in protecting public safety or health, or providing greater privacy protections. Aeisha is a beginning therapist working with the Robinson family. The family is seeking treatment because their 15 year old son, was caught shoplifting. Aeisha feels like the family is challenging and resistant to her suggestions for change. In her next session, Aeisha spends more time joining with the family and asking how they thought therapy should proceed. After this session, Aeisha begins to reformulate an approach that is more consistent with the family’s view of the problem. She soon discovers that movement is beginning to happen in therapy. According to research, Aeisha this family may have been presenting: c. therapist resistance. In a qualitative study, Kuehl, Newfield and Joanning, 1990, describe how families being treated for adolescent drug abuse experience family therapy. The researchers not that families can sometimes encounter "therapist resistance" when therapists become more insistence in promoting their agenda for therapy despite the families reservations. The researchers label this "therapist resistance." Epston and White regard problems as something which influence or operate on people, rather than as something they're doing wrong. The Narrative technique utilized to accomplish this is: d. externalizing. The Narrative Model seeks to disassociate the “problem” from the person, moving the problem almost to a poltergeist status. Once externalized, it is given "Proper Noun" status and can be referred to which further emphasizes the choices family members have in regards to it.

PRACTICE TEST 3