MFT Practice Test

In Cognitive Behavioral Systems Therapy, the MFT grows the therapeutic relationship by working as a partner with the client/client family versus leading the counseling relationship. When the client/client family feels they are an equal partner in the sessions, they feel more connected and motivated.

Differentiation of self is a concept in systemic family therapy in which a particular family member can separate himself or herself from the conflict, discord, or emotional drama of the family unit and is seen as a healthy means of interaction. The multigenerational transmission process in family therapy refers to how aspects of one's family dynamics can be transferred throughout generations via both conscious and unconscious channels. Sibling positioning is a Bowen Family Therapy concept that theorizes that those with similar sibling positions will have parallel emotional characteristics within their respective family units. Emotional cutoff in family therapy is characterized by a family member attempting to address emotional discord by ceasing all emotional contact with the respective family member(s). It is often seen as a maladaptive way of handling family communication.

Joining is when the MFT takes initial session time to get to know the family and each of their expectations for the counseling process. It allows the family to become comfortable with therapy, the therapist, as well as the therapy process. This process assures the family members that the MFT empathizes with them as well as helps them overcome anxiety about the process.

Circular questioning involves having family members engage in dialogue regarding the relational facets of the subject being discussed in the counseling session. It is different from linear questioning which determines facts versus asking the family members to explore and reflect on the situation at hand. Reframing is used to try to see something from another angle but does not necessarily involve questioning specifically. Linear questions are relatively straightforward and limited to "who, what, why, where" inquiries for the MFT to determine what the client perceives is going on within the larger scope of a client's situation. Comparatively, closed-ended questions by the MFT are ones that require one-word, succinct answers such as "yes, no, maybe" and do not usually provide as much therapeutic information as other methods of interviewing.

All elements of culture, sexual orientation, and identity of gender as well as how they relate to each family member within the system is important in working with the family system and individual client. That being said, it is vital to also understand these concepts in the larger scope of society and their relationships to the MFT discipline.

Oppositional defiant disorder would be the most accurate diagnosis for Michael. The key factor of this diagnosis is his tendency to argue with authority figures in all domains of his life. Oppositional defiant disorder differs from conduct disorder in that conduct disorder involves specifically violating laws, rules, or society as well including a component of aggression. ADHD, or Attention Deficit Hyperactivity Disorder, is indicative of a youth who has difficulty paying attention and is impulsive but does not characteristically display intentionally aggressive and disobedient behavior intentionally. Dysthymic disorder falls under the category of a depressive disorder and is considered a more chronic and milder form of sadness versus other depressive diagnoses.

When assessing family members, it is important to look at each of these factors. It is important to comprehend not just the content of conflict but how the family addresses and handles discord as well as the history of doing so. It is also necessary to know how the family handles boundaries (both inside and outside the family unit) as well as what each member expects of the other members of the collective family unit.

Hypothesizing involves developing suppositions within the systemic process of a family. The MFT should attempt to make the hypothesis positive in nature as well as recognize it may change depending on future information shared with the MFT. Hypothesizing is not assessing or diagnosing the family. It is only an educated guess that can change as counseling progresses. Circular questioning involves having family members engage in dialogue regarding the relational facets of the subject being discussed in the counseling session. Assessing is the practice of evaluating relational, individual, and environmental characteristics through observation (instead of making suppositions in hypothesizing). Diagnosing is applying a label, or labels, of a mental disorder to the client's presenting problem and is completed after a more in-depth understanding is surmised about the client's issue(s).

The licensed therapist should check the rules of their individual state licensing board within which they are practicing to ensure the test is permitted and they should have received training on the specific test.

Couples therapy is contraindicated in cases of intimate partner violence, so a marriage and family therapist will typically not continue couples therapy if there is known violence. Additionally, while couple therapy may entail some individual work, an MFT does not typically conduct individual therapy with either part of a couple system. If there is known violence in a couple, the best clinically appropriate action is to suspend couple therapy, refer the husband to individual counseling, and provide resources and a safety plan to the wife.

Transference occurs when a client transfers the feelings that they have about a figure of authority onto someone else that they assume to be in power (in this case, the therapist). In contrast, countertransference is when the MFT responds to the client with his or her own beliefs or assumptions about the client accordingly. Oedipal complex is a now, largely dismissed, Freudian therapy term that theorizes that a child will have an attraction to the parent of the opposite sex as well as jealousy and anger toward the parent of the same sex due to their marital relationship. Anticipatory anxiety is the worry and fear that occurs before a person does something that may evoke such emotions.

Structural family therapy involves looking at the structure of the entire family unit and, when necessary, making changes in rules, boundaries, and relationships. In doing so, the mapping of a client family tree (also known as a genogram) helps the MFT and the family see the family as a system versus individuals existing in the same unit. The goal of this therapy is to look at the family as a system versus as individuals. Solution-focused therapy is usually short-term in duration and is only interested in finding an immediate solution to the presenting problem and not generally in the history, symptoms, or past issues that the client may present or have presented. EMDR Therapy stands for eye movement desensitization and reprocessing and is utilized primarily for trauma issues. EMDR involves eye movement exercises that have the objective of reprogramming memories to reduce traumatic memories for the client. Cognitive behavioral therapy (CBT) considers distorted or unhealthy ways that clients may think about problems and seeks to replace these thoughts with more healthy and productive thinking patterns.

In Narrative Family Therapy, the MFT designs interventions that help clients develop a better idea of the values that are vital to them and teach them how to develop them more productively. It also works to change some of the dominant thought processes that limit clients or create destructive beliefs. One of the techniques used within this repertoire is deconstruction, in which the MFT encourages the client to avoid overgeneralization of issues and simultaneously develop a new description of their life history and problems. Structural Family Therapy comprises of observing the structure of the entire family unit and, when necessary, making changes in rules, boundaries, and relationships. Brief solution-focused therapy is always intended to be short-term in duration and is interested in finding the immediate solutions to the presenting problem and not in the history, symptoms, or past issues. Strategic family therapy sees the aim of the MFT to observe and change how family members individually react as well as how they function together as a unit. This model is often considered for issues of child/adolescent substance abuse, oppositional defiant, or conduct disorders.

The priorities in treatment planning, ideally, should center around a collaboration between MFT, client and the client family (if applicable). The exception is in the case of danger to self or others, in which safety must always be a priority.

Reframing is a type of questioning and not considered a stage, per se, in the ongoing process of family therapy. The five stages of family therapy are: joining, identification, shifting, maintenance, and termination. In joining, the MFT introduces the concept of counseling, while in identification, the MFT clarifies problems, boundaries, and established goals. Shifting requires the MFT to transition from problems to potential solutions. In maintenance, the MFT establishes means of bolstering and supporting progress, and finally, in termination, the MFT will end therapy effectively with the family.

Negative feedback is when a client, or client family, seeks to maintain homeostasis or the status quo. In contrast, positive feedback occurs when a family member, or family members, seek to encourage change within the family dynamic. Circular questioning involves having family members engage in dialogue regarding the relational facets of the subject being discussed in the counseling session. Supportive feedback, as the name suggests, is to bolster and validate the client/client family verbally in some manner.

Abandonment is when the client has not had their treatment needs met nor have they been provided an appropriate referral to another qualified mental health professional. Abandonment can be traumatizing for the client and is considered unethical and can also result in legal ramifications for the MFT. That being said, termination is appropriate in situations where the MFT determines that the family can no longer benefit from counseling with the current MFT and provides an appropriate termination protocol.

A teletherapy follow-up is not required for a termination. When terminating counseling it is important that the MFT address why therapy is concluding at the particular juncture that they are doing so. Treatment goals that have been established and agreed upon by the MFT and family should be reviewed to determine that goals have been met or attempted to the best of the MFT and family's abilities. Finally, it is important that a natural closure and debriefing occur among both parties.

A systemic perspective indicates that every member of the family plays a role in the interactions and behavior. The index client is the one who simply displays the symptoms of these interactions. Hence, an MFT looks towards the web of all family members versus a single person.

Thoughts of suicide are not a sufficient reason alone for termination. Termination is warranted if an individual is not benefitting or is being harmed by treatment, if the therapist is threatened or endangered in some way by the client and if the therapist does not have the necessary competence to meet the client's treatment needs.

Under Tarasoff v. Regents of the University of California, therapists must warn potential victims of harm if a client makes an overt threat against the potential victim. Some states also require the MFT to contact the local police department and report the nature of the threat as well (but not necessarily detaining the client while doing so).

The MFT must report all suspicions of child abuse or neglect to their local division of child protective services. Asking further questions to determine the nature or substantiation of the abuse or neglect claims may impede the state's investigation.

The Columbia scale is most commonly recognized for assessing suicidal ideation because it is the most evidenced-based scale, very short in the application process, available in over 100 languages, and can be used with almost any age group. The Patient Health Questionnaire (PHQ-9) is a depression assessment that measures the degree of depressive symptoms based on scoring level. The Vanderbilt Questionnaire is a survey used to measure potential ADHD in children from 6-12 years of age. The Brief Psychiatric Rating Scale (BPRS) is reserved for clients with psychosis and is a measurement of the severity of psychotic pathological symptoms within these persons.

Consultation with another MFT will help Michael to see the situation from another angle and think through the challenging dilemmas that Lucas's case represents before making a clinical decision. It will also assist in the avoidance of any triggering emotions that Michael may be experiencing in the sessions (also known as countertransference).

Several issues arise when considering teletherapy in relation to crisis clients. First, is the distance from the client. It may be difficult, or impossible, to get to a client physically to assist, if necessary, in a crisis situation. Second, each region of the country has varying levels and types of organizations as well as psychiatric facilities that an MFT who does not live in the area may not be familiar with. Additionally, states have varying laws regarding clients in crisis and the MFT may be unfamiliar with those laws.

During the informed consent process, the limitations of confidentiality should be discussed so that the client recognizes what issues must be referred to the attention of other organizations, persons, agencies, or personnel. These include threats of danger to self or others, abuse or neglect of children, seniors, or developmentally disabled persons.

Before counseling can begin, it is necessary to review and sign an agreement for informed consent. Informed consent allows clients to understand and be aware of the benefits and risks of counseling, confidentiality, and limits, as well as treatment and procedure details. All persons who sign this document must be able to understand the forms and the MFT should keep these as a part of the client's files. Release of information, development as well as signing of the treatment plan, and the process of joining with clients are all necessary components after the MFT has secured informed consent.

This is an example of a multiple or dual relationship with the client, which is an ethical violation. In a multiple or dual relationship, the interaction between the MFT and the client leaves open the possibility of exploitation or can create an impairment of the MFT's judgment in the therapeutic relationship. It also leaves open the possibility for abuse of the therapeutic bond.

Legally, in most states, an MFT must keep full records for seven years for an adult client after the date of services or three years after a child reaches the age of adulthood whichever is later. After this date, records must be destroyed in an appropriate manner such as shredding or permanent erasure of digital media. It should be noted that though most states have record retention laws, not all states do.

The AAMFT requires the following to become licensed as a family therapist: passing an exam by the AAMFT, and completing no more than 1,150 hours of direct client contact. Following this, 50 hours of direct supervision, at one hour per week, by an AAMFT-supervised therapist with a limit of 300 hours of other internship activities is required. It is important to note that no more than 30 hours of experience completed weekly can be counted and no more than 125 hours may be earned in any one month toward license completion.