Free AMFTRB Marital and Family Therapy National Examination Practice Questions

Sample Practice Questions

Try these 10 sample questions from the AMFTRB Marital and Family Therapy National Examination practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A therapist tells a family that the reason the whole household is being asked to attend, rather than only the teenager whose behavior prompted the referral, is that families operate as systems. Which statement states the systemic premise the therapist is relying on?

   1. A. Each part of the family is related to all of the other parts, so a change in any one part of the system brings about changes in all of the others.
   2. B. Each family member's behavior is learned and maintained by reinforcement that the other members supply, so behavior changes when reinforcement changes.
   3. C. Each family carries an inherited vulnerability that behaves like other chronic medical conditions, so all members share the same underlying risk.
   4. D. Each family member occupies his or her own developmental stage of change, so the household changes only when enough members reach the action stage.

   Answer: A

   Explanation: SAMHSA's TIP 39 states the systemic premise directly: "A systems model underlies family counseling. The model views families as systems, and in any system, each part is related to all other parts. A change in any part of the system will bring about changes in all other parts." That is the reason for convening the household rather than the identified member alone. Option B states the premise of cognitive-behavioral theory, option C the premise of the chronic disease model, and option D the stages-of-change framework; TIP 39 presents each of these as a real but different account of how family-based change works, and none of them supplies the reason for treating the family as the unit.

   Reference: Samhsa Tip39 — Chapter 1, 'Family Counseling: What Is It, and Why Is It Useful?', p.5

2. 2In a first session, a 15-year-old glances at her mother before answering each of the therapist's questions, and the father rolls his eyes whenever his wife speaks. What do these behaviors give the therapist information about?

   1. A. Relationship dynamics in the family, including alliances and the presence or absence of support and respect between members
   2. B. The accuracy of each member's account of the presenting problem, since nonverbal behavior reveals which accounts are withheld
   3. C. The family's stage of change, since the nonverbal hesitation indicates that members are still in precontemplation
   4. D. The family's boundary structure, since nonverbal checking shows that the boundaries between generations are rigid

   Answer: A

   Explanation: TIP 39 treats communication patterns as data about relationships: "They can indicate support and respect, or lack thereof, between family members. For example, a teenager in family counseling may look to a parent before answering a question; a husband may roll his eyes when his wife speaks." Option B treats nonverbal behavior as a lie-detection cue, which the source does not support. Options C and D each name a real construct TIP 39 defines -- stages of change and boundary types -- but neither is what a single instance of glancing or eye-rolling establishes; both would require the separate assessments the same TIP describes.

   Reference: Samhsa Tip39 — Chapter 1, 'Communication Patterns', p.14

3. 3In the opening phase of a family-based treatment for an adolescent, a therapist finds that she has established a strong working relationship with the parents but the adolescent remains guarded. What does the model's first-stage requirement direct her to do?

   1. A. Continue building the foundation until therapeutic alliances exist with all family members, since multiple alliances are the basis for change
   2. B. Proceed to the change phase with the parents, since parental engagement is the mechanism through which adolescent behavior changes
   3. C. Shift the adolescent to individual sessions with a different clinician, since a guarded adolescent cannot be engaged in family work
   4. D. Ask the parents to require the adolescent's participation, since compliance normally precedes engagement in adolescent treatment

   Answer: A

   Explanation: In the first stage of multidimensional family therapy, "Stage I: Build the foundation," the listed tasks begin with "Develop therapeutic alliances with all family members." Among the model's principles is that "Multiple therapeutic alliances are needed as a foundation for change." Option B advances to the second stage before that foundation exists. Option C removes the adolescent from the family unit of treatment. Option D substitutes coercion for alliance, which conflicts with the same TIP's guidance that the counselor's first move with a reluctant participant is to understand the reluctance.

   Reference: Samhsa Tip39 — Chapter 3, MDFT stages, p.53; Exhibit 3.1, MDFT principles, p.45

4. 4A therapist notices that a family's engagement has dropped after a difficult session, and wants an instrument that will show whether family functioning is changing over the course of treatment. Which instrument is designed for that purpose, and how should it be used?

   1. A. A brief validated self-report measure of family functioning, administered at the outset of counseling and at intervals throughout treatment
   2. B. A brief validated self-report measure of family functioning, administered once at intake to establish the family's baseline profile
   3. C. A structured diagnostic interview conducted with each member, repeated whenever the family's engagement declines during the work
   4. D. A substance use severity index for the identified client, since family functioning can be inferred from that one client's status

   Answer: A

   Explanation: TIP 39 describes the SCORE-15 Index of Family Functioning and Change: it "is a brief, validated self-report outcome measure designed to be sensitive to systemic family changes that can take place in couples and family counseling," and instructs clinicians to "Administer the instrument at the outset of family counseling and at intervals throughout treatment to measure changes in family functioning." Option B stops at baseline and cannot show change. Option C substitutes diagnostic interviewing for an outcome measure. Option D infers family functioning from one member's status, which the same TIP rejects in expanding outcome measures to the whole family.

   Reference: Samhsa Tip39 — Chapter 6, Exhibit 6.7, SCORE-15 Index of Family Functioning and Change, p.140

5. 5Three days after a tornado destroyed part of a town, a client cannot state the date, cannot recall the previous day's events, and does not know where she is. Which course does disaster mental health guidance direct?

   1. A. Treat the disorientation as a signal to consult the appropriate professional and, in most cases, sensitively refer her for further assistance
   2. B. Treat the disorientation as an expected reaction to an abnormal situation that will resolve on its own without any referral at all
   3. C. Treat the disorientation as grounds for immediate involuntary transport, since she cannot give any coherent account of herself at all
   4. D. Treat the disorientation as a reason to postpone all further contact until the immediate relief phase of the response has ended

   Answer: A

   Explanation: The field manual lists reactions that "signal a need for the worker to consult with the appropriate professional and, in most cases, to sensitively refer the survivor for further assistance," beginning with "Disorientation — dazed, memory loss, inability to give date or time, state where he or she is, recall events of the past 24 hours, or understand what is happening." Option B applies the general principle that "Disaster stress and grief reactions are normal responses to an abnormal situation" to a presentation the manual singles out for referral. Option C escalates beyond what the guidance directs, and option D withholds contact when the guidance calls for active outreach.

   Reference: Field Manual for Mental Health and Human Service Workers in Major Disasters — 'When To Refer for Mental Health Services'; 'Key Concepts', p.2

6. 6During family work, a therapist concludes that the presenting issue requires expertise in an area in which he has no education, training, or supervised experience. Which enforceable standard applies to how he revises his role in the case?

   1. A. Therapists do not diagnose, treat, or advise on problems outside the recognized boundaries of their competencies
   2. B. Therapists may treat problems outside their competencies provided the clients are informed and give written consent
   3. C. Therapists may treat problems outside their competencies if no other qualified provider is available in the area
   4. D. Therapists may treat problems outside their competencies while concurrently enrolled in relevant continuing education

   Answer: A

   Explanation: The AAMFT Code of Ethics states: "Marriage and family therapists do not diagnose, treat, or advise on problems outside the recognized boundaries of their competencies." The same code requires that therapists "practice in specialty areas new to them only after appropriate education, training, or supervised experience," and that they "make reasonable efforts to provide current, former, or prospective clients with appropriate referrals if the marriage and family therapist is unable or unwilling to provide professional help." Options B, C, and D each create an exception -- consent, scarcity, or concurrent coursework -- that the code does not recognize.

   Reference: Aamft Code of Ethics — Standard III, 3.10 Scope of Competence and 3.6 Development of New Skills; Standard I, 1.9 Referrals

7. 7During a case consultation a therapist describes a household in which meals, money, and the children's chores have all been rearranged since one parent's drinking worsened, and in which no one names the drinking aloud. Which of the four theories that inform current family-based practice is the therapist drawing on when she accounts for that arrangement?

   1. A. Families organize themselves through their interactions around the substance misuse, and in adapting to it the family tries to keep its balance.
   2. B. Behaviors, including the substance misuse itself, are reinforced through the family's interactions, so changing those interactions changes behavior.
   3. C. The condition resembles other chronic medical conditions and carries a genetic component, so it affects every member of the family as an illness would.
   4. D. Change occurs by multiple pathways, in different contexts, and through diverse mechanisms across the adolescent, the parents, the family, and community.

   Answer: A

   Explanation: TIP 39 sets out four theories that inform current family-based approaches and describes this one as follows: "Family systems theory holds that families organize themselves through their interactions around substance misuse. In adapting to substance misuse, the family tries to maintain homeostasis." The other three named options are the remaining members of that same list and are defined differently in the same passage: cognitive-behavioral theory "assumes that behaviors, including substance misuse, are reinforced through family interactions"; the chronic disease model "views SUDs as similar to other chronic medical conditions and acknowledges the role of genetics"; and multidimensional family therapy "integrates techniques that emphasize the relationships among cognition, affect (emotionality), behavior, and environment."

   Reference: Samhsa Tip39 — Chapter 1, 'Current Models for Including Families in SUD Treatment', p.16

8. 8A mother telephones her adult daughter to complain about her son's drinking instead of raising it with the son. The daughter listens and does not redirect her. What directional pattern in family communication does this illustrate?

   1. A. Triangulation
   2. B. Enmeshment
   3. C. Parentification
   4. D. Scapegoating

   Answer: A

   Explanation: TIP 39 defines the pattern and gives this exact illustration: "Triangulation happens when, instead of communicating directly with a family member who has an SUD, families who are under stress or lack coping skills instead talk around the person or with a third party in the family system," and "Triangulation often includes a third person as a go-between, an object of concern, or a scapegoat." Options B, C, and D name three other real phenomena defined in the same TIP: boundaries that are "too loose or too enmeshed," a child "assuming adult roles that are not age-appropriate," and a family role that "Draws attention away from the family member with an SUD by getting into trouble." None of them describes a message routed through a third party.

   Reference: Samhsa Tip39 — Chapter 1, 'Communication Patterns', p.14; 'Boundaries', p.13; 'Subsystems', p.11; Exhibit 2.4, p.35

9. 9A family has been referred by a child protection agency, which expects periodic reports on participation. What must the therapist establish with the family as part of contracting for the work?

   1. A. Agency policies, the family's rights and responsibilities as clients, the therapist's legal and ethical obligations, and signed releases covering reports to the referring body
   2. B. A written agreement that no information at all will leave the sessions, with the referring agency informed only of the dates on which the family attended and of nothing further
   3. C. An understanding that the therapist's reports will be shared with the family only after the referring agency has reviewed them and has agreed to their release to the family
   4. D. An agreement that the family will withdraw any objection it has to the referral, and will not raise that objection again, before any therapeutic work begins in the sessions

   Answer: A

   Explanation: TIP 39 directs the clinician working with a mandated family to "Address the issue of communicating with the referring organization," to "share with them any requirements you must follow regarding release of information or progress to the referring organization," and to "Inform all family members about agency policies, their rights and responsibilities as clients, and your legal/ethical responsibilities as a counselor. Have family members sign all pertinent releases as part of this informed consent process." Option B promises confidentiality the referral arrangement does not permit. Option C reverses the disclosure the same passage requires toward the family. Option D conditions treatment on the family abandoning its objection, which is not part of contracting.

   Reference: Samhsa Tip39 — Chapter 4, 'Mandated Family Counseling', p.78

10. 10A program director asks why routine outcome monitoring should be added to family services that clinicians already believe are working. What does the evidence on routine outcome monitoring show?

    1. A. It improves clinically significant client outcomes and enhances counselors' ability to predict and prevent client deterioration
    2. B. It shortens average length of treatment without changing outcomes, so its value lies in efficiency rather than effect
    3. C. It improves outcomes only where clinicians are blinded to the results, since knowing the scores biases subsequent sessions
    4. D. It has been validated for individual treatment but not for family services, where no outcome instrument of any kind exists

    Answer: A

    Explanation: TIP 39 states: "Strong evidence suggests that using a routine outcome monitoring (ROM) system in behavioral health service settings improves clinically" significant "client outcomes and enhances counselors’ abilities to predict and prevent client deterioration." Option B substitutes an efficiency claim for the outcome finding. Option C reverses the mechanism, since the same passage describes feedback systems that clinicians use. Option D is contradicted by the SCORE-15 Index of Family Functioning and Change, which TIP 39 describes as designed specifically "to measure outcomes of family counseling."

    Reference: Samhsa Tip39 — Chapter 6, 'Outcomes', p.139