Counseling Families, Diagnosis, and Advanced Concepts

84 important questions on Counseling Families, Diagnosis, and Advanced Concepts


A married couple brings their two children to counseling for behavioral problems. The 14-year-old daughter stays out late and their 17-year-old son is using drugs. According to most marriage and family therapists the identified patient would be
a.the 17-year-old son.
b.the 14-year old-daughter.
c.the family.
d.both children.

c.the family.

Most family counselors believe that the entire family system, which is really a natural social system, is dysfunctional. Hence the entire family is the identified patient and in need of treatment. Traditionally, the identified patient (IP) was seen as the person who was having a problem. Unfortunately, for insurance purposes you may need to pick a family member to diagnose as the identified patient even though this goes against what most family therapists believe!


You are supervising a licensing candidate who is primarily interested in marriage and family counseling. You are very attracted to her and have sex with her. According to ethics guidelines
a.this is perfectly ethical, since this is a student and not a client.
b.this is unethical.
c.this is perfectly ethical, since this is a supervisee and not a client.
d.a and c are both correct.

b.this is unethical.

There’s a clear-cut answer here folks: Counselors should never engage in sexual relationships with students or supervisees. The fact that the supervisee is interested in marriage and family counseling is totally irrelevant.


Cybernetics is a concept used by family therapists. It is usually associated with the work of
a.Freud and Ellis.
b.Norbert Wiener.
c.Virginia Satir.
d.behavioral family therapists and cognitive family therapists.

b.Norbert Wiener.

Cybernetics was pioneered in the early 1940s and named (from the Greek word for steersman) by MIT mathematician Norbert Wiener. Wiener was asked to investigate how guns could be aimed to hit moving targets. He teamed up with mathematician John Von Neumannn, who worked on the Manhattan Project in Los Alamos, New Mexico, the site of the first U.S. nuclear weapons production. This information, which initially related to machines, was used to analyze family systems thanks to Gregory Bateson. In family therapy, cybernetics suggests that the family has feedback loops to self-correct a family system.
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Adaptability is the ability of the family to balance
a.ego strength.
b.stability and change.
c.morphostasis and morphogenesis.
d.b and c.

d.b and c.

Morphstasis is the ability of the family to balance stability while morphogenesis refers to the family’s ability to change.


Virginia Satir felt that a major goal of therapy was to improve intrafamily communication (i.e., communication between family members). According to Satir, four basic patterns prevented good communication under stress. These defensive postures or stress positions are: placating, blaming, being overly reasonable, and being irrelevant. Placating means
a.you disagree with all the other family members.
b.you pick a favorite family member and agree with him or her.
c.you ignore the other family members.
d.you try to please everybody out of a fear of rejection.

d.you try to please everybody out of a fear of rejection.

The placating style causes the individual to sacrifice his or her own needs as a way of dealing with stress.

The placater is a people pleaser under stress while the blamer


a.will sacrifice others to feel good about himself.
b.will often say “if it weren’t for you….
c.will point the finger at others to avoid dealing with his or her own issues.
d.all of the above are typical behaviors of the blamer. 

d.all of the above are typical behaviors of the blamer. 

The blamer basically asserts that, “It’s your fault I’m the way I am.”


The person who becomes overly reasonable
a.practices excitation.
b.cries a lot during therapy sessions.
c.is likely to engage in the defense mechanism of intellectualization.
d.has a high degree of emotion.

c.is likely to engage in the defense mechanism of intellectualization.

Choice “a” is an old term for expressing true emotion—basically the opposite of what the overly reasonable person does! Some of the literature describes this individual as “functioning like a computer” to keep his or her emotions in check. The person is emotionally detached. Exam hint: Your test could refer to the overly reasonable client as the responsible analyzer.


According to Satir, the individual displaying an irrelevant style
a.will distract the family from the problem via constantly talking about irrelevant topics.
b.will become a people pleaser.
c.will analyze the situation more than most.
d.all of the above.

a.will distract the family from the problem via constantly talking about irrelevant topics.

Choice “a” is typical of this dysfunctional type of communication. Choice “b” is clearly the pattern of the placater, while choice “c” describes the overly reasonable client.


Carl Whitaker’s interaction with the family could best be described as
a.quiet and empathic.
b.joining the family and experiencing it as if he were a family member.
c.a reality therapist.
d.a cognitive behavior therapist.

b.joining the family and experiencing it as if he were a family member.

Whitaker, a psychiatrist by training, intentionally minimized the importance of theory, noting that therapeutic interaction is more of an art. Note that although some theories created for individual counseling (e.g., reality therapy or Adlerian) can be used with families and couples. Nevertheless, other approaches such as Whitaker’s that emphasize systems are unique and generally not covered in sources and courses that focus only on individual models.


According to Whitaker,
a.a cotherapist is helpful.
b.a cotherapist should never be used.
c.a cotherapist should be used only with blended families.
d.all of the above could be true.

a.a cotherapist is helpful.

Whitaker felt that a cotherapist can provide meaningful feedback and allows the therapist to be an active participant in the therapy rather than merely a teacher.


Psychotherapy of the absurd is primarily related to the work of
a.Virginia Satir.
b.Carl Whitaker.
c.Maxie C. Maultsby, Jr.
d.William Glasser.

b.Carl Whitaker.

Whitaker could be wild at times. A couple who was in a power struggle, for example, might be asked to have a tug of war in order to prove who really had control! Maultsby—the psychiatrist in choice “c” is noted for creating rational self-counseling that is similar to Ellis’s REBT.


A behavioristic marriage and family therapist is counseling the entire family together. She turns to the 18-year-old son who is attending community college and says, “You must complete your sociology essay before you can use the family car and go out with your friends.” Which theorist is primarily guiding her intervention strategy?
a.David Premack’s principle or law.
b.Ivan Pavlov and John B. Watson
c.B. F. Skinner
d.all of the above

a.David Premack’s principle or law.

Behaviorists who practice marriage and family therapy rely on the same theorists as individual practitioners of this persuasion. All of the theorists listed are behaviorists. Premack’s work, nevertheless, suggests that a family member must complete an unpleasant task (known as a low probability behavior LPB) before he or she would be allowed to engage in a pleasant task (known as a high probability behavior HPB).


A behavioristic marriage and family counselor is counseling the entire family together. She turns to the 18-year-old son who is attending community college and says, “I know you like to play golf. Therefore, every time you cut the grass your father will take you to play golf. I am going to have you and your dad sign a contract that you agree with this policy.” Which principle is primarily guiding her strategy?
a.negative reinforcement.
b.thought stopping.
c.shaping with successive approximations.
d.quid pro quo.

d.quid pro quo.

In Latin quid pro quo means “one thing for another,” “something for something” or “this for that.” Gee, I knew there was some reason I spent two years studying a dead language in high school! Anyway, this technique, which generally makes use of a behavioral contingency contract, is based on the notion that one person in the family will do something as long as the other member agrees to do something comparable. Just for the record, all of the choices are behavioristic.


A male is supervising a female counselor for state licensing. He tells her that he will continue to supervise her as long as she has sex with him. This is an example of
a.quid pro quo.
b.a legal but not an ethical violation.
c.a and b.

d.none of the above

a.quid pro quo.

Surprise! The correct answer is choice “a.” Here the term (i.e., quid pro quo) is being used in a different context in a negative manner that constitutes sexual harassment. Needless to say, the term still has “something for something” or “you do this for me and I’ll do this for you” connotations. Expect to see it in either context on your exam. Choice “b” is incorrect since this is indeed an ethical violation.


A behavioristic family counselor suggests that the family chart the number of times that 6-year-old Billy says “no” when he is told to do something. The baseline of the chart would refer to
a.the period when positive reinforcement is being implemented.
b.the period when negative reinforcement is being implemented.
c.the period when quid pro quo is being implemented.
d.the period before the behavior modification begins.

d.the period before the behavior modification begins.

In behaviorism, a baseline is merely a measure of the behavior prior to the treatment or when treatment is not being implemented. Exam hint: On some exams the baseline is signified via the upper-ease letter “A” while the behavior modification treatment is written with an upper-case “B.”


The family counselor explains to Mrs. Smith that the next time that 9-year-old Sally hits her little brother she must sit in the family room by herself. The counselor is using
a.shaping.
b.shaping with successive approximations.
c.reciprocity.
d.time-out, a procedure that most behaviorists feel is a form of extinction.

d.time-out, a procedure that most behaviorists feel is a form of extinction.

Time-out occurs when a family member (usually a child) is isolated or removed from an environment for a specified period of time so as to ensure that he or she does not receive reinforcement for dysfunctional behavior.


A couple is having sexual problems that stem from anxiety. A marriage counselor who is a strict behaviorist would most likely
a.dispute the couple’s irrational thinking.
b.prescribe thought stopping.
c.rely on systematic desensitization procedures.
d.rely primarily on paraphrasing and reflection.

c.rely on systematic desensitization procedures.

Joseph Wolpe’s systematic desensitization pairs feared mental imagery with relaxation to eliminate the fear and relaxation. Choice “a” isn’t necessarily a poor choice since it refers to rational-emotive behavior therapy (REBT; formerly known as RET or rational-emotive therapy) that does employ behavioristic techniques. Nevertheless, a strict behaviorist would be more likely to rely on a purist technique such as systematic desensitization.


A family counselor notices that the husband in a blended family is having obsessive sexual thoughts about a woman living down the street. A strict behaviorist would most likely
a.analyze the man’s dreams.
b.have him chart the incidence of the behavior, but do little else.
c.practice thought stopping.
d.rely primarily on Joseph Wolpe’s systematic desensitization.

c.practice thought stopping.

Behavioral family therapy first appeared on the scene in the late 1960s, initially focusing on kids in the family who had problems. Psychologist Gerald Patterson (who popularized behavioral parent training in the family’s home), psychiatrist Robert Liberman, and social worker Richard Stuart (who created operant interpersonal therapy) are generally cited as the pioneers of this approach. Thought stopping is intended to do just what it sounds like—stop thoughts! The man would be taught to yell in his mind stop! as loudly as possible every time he experienced a sexual thought related to his neighbor.


All of the techniques listed below would be used by a behavioristic family therapist except
a.family sculpting.
b.a functional analysis of behavior followed by operant conditioning.
c.modeling.
d.chaining and extinction.

a.family sculpting.

Family sculpting, popularized by Virginia Satir, is an experiential/expressive technique in which a family member places other family members in positions that symbolize their relationships with other members of the family. Finally, the member places him- or herself. This helps the therapist understand family dynamics that might be missing from a mere discussion of family issues.


Which statement is true of families?
a.The divorce rate has decreased markedly in the last several years.
b.Remarriage today is uncommon.
c.Remarriage today is common.
d.The divorce rate in the United States hovers at about 10%.

c.Remarriage today is common.

Remarriage is almost as common as marriage! Approximately half of all marriages include a remarriage for one partner and in about 25% of all marriages both parties are getting remarried. Choices “a” and “d” are incorrect inasmuch as the divorce rate is stable at about 50%.

Which statement is true?


a.Single life is short-lived for divorced persons. About 30% of all divorced persons are remarried within 12 months of being divorced.
b.Most persons who are divorced do not remarry.
c.Most persons who are divorced wait a minimum of five years to remarry.
d.Women remarry quickly, however, men do not. 

a.Single life is short-lived for divorced persons. About 30% of all divorced persons are remarried within 12 months of being divorced.

Some experts forecast that in the 21st century stepfamilies may out number traditional families. After a divorce the median interval for remarrying is 2.3 years for men and just 2.5 years for women.


The theory of psychodynamic family counseling is primarily associated with
a.William Glasser.
b.Sigmund Freud.
c.Virginia Satir and Carl Whitaker.
d.Nathan Ackerman.

d.Nathan Ackerman.

Although Freud is the Father of psychoanalysis, it was Ackerman—an analytically trained child psychiatrist—who as early as 1938, recommended studying the family and not just the child who was brought into treatment as the identified patient. Some experts consider this the true beginning of the family therapy movement. Because he was analytically trained, Ackerman—unlike many family therapists—was concerned with the internal feelings and thoughts of each individual as well as the dynamics between them. Prior to Ackerman it was considered inappropriate to include family members in analytic treatment sessions.


In psychoanalytic family therapy the word object means
a.a dream.
b.a significant other with whom a child wishes to bond.
c.transference.
d.countertransference.

b.a significant other with whom a child wishes to bond.

This is the notion that an individual (or the individual’s ego) attempts to establish a relationship with an object—often a person or a part of the body—to satisfy needs. When this does not occur anxiety is manifested.


In psychoanalytic family therapy the term introjects really means that the client
a.internalizes the positive and negative characteristics of the objects within themselves.
b.possesses internal verbalizations.
c.possesses a finite number of problem solving options.
d.possesses the internal motivation to solve his or her own difficulties.

a.internalizes the positive and negative characteristics of the objects within themselves.

Eventually, these introjects (taking in personality attributes of others that become part of your own self-image) determine how the individual will relate to others.


Pick the best example(s) of the psychoanalytic concept of splitting.
a.A client who realistically perceives her therapist as a very empathic person.
b.A client who realistically perceives her therapist as only having good qualities.
c.A client who sees her therapist as all bad.
d.b and c.

d.b and c.

Splitting occurs when the client sees an object (another person) as either all good or all bad. Splitting allows one to keep anxiety in check by making objects predictable. This tendency begins in childhood, usually by categorizing one’s mother as all good or all bad. Removing dysfunctional introjects from childhood is curative.

A 72-year-old woman you are counseling in a family reminds you of your mother and this is bringing up unresolved childhood issues for you as the counselor. This is an example of


a.positive transference.
b.negative transference.
c.countertransference.
d.ambivalent transference. 

c.countertransference.

Yes, I realize that I have introduced you to these concepts earlier in the text, nevertheless, repetition can help ensure that you truly understand the concepts. Countertransference occurs when a counselor has an unresolved issue that impacts the treatment. A strict psychodynamic theorist would assert that the counselor has an unconscious reaction to the family or the 72-year-old woman that is similar to a reaction he or she experienced in a previous situation; often his or her own childhood.


A woman sees her husband as all good sometimes and all bad at others. An analytically trained family therapist who believes in object relations would see this as
a.ambivalent transference.
b.splitting.
c.dysthymia.
d.psychotic behavior.

b.splitting.

Here is another type of splitting (the first type is depicted in question 934). As a child this woman internalized an image of her mother as all good at times and all bad at others. She now adheres to this pattern as an adult. Choice “c,” dysthymia, is a term I would definitely commit to memory for your exam. It refers to a low level depression that occurs more days than not for at least one year in kids and teens and for at least two years in adults.

Cloe Madanes and Jay Haley are associated with the _______ school of family counseling.


a.strategic.
b.behavioral.
c.psychodynamic.
d.object relations. 

a.strategic.

Haley is the name we associate most with this area. Haley was impacted by the late great Milton Erickson (not Erik Erikson!) who believed in “designing a strategy for each specific problem.” It has been said that Haley helped alter Erickson’s work so that it helped families as much as individuals. Haley actually coined the term strategic therapy to explain Erickson’s method.


When Haley began investigating psychotherapy he
a.was already trained as a Freudian analyst like so many other pioneers in the field.
b.was already trained as a behaviorist.
c.had studied REBT with Ellis.
d.had a degree in the arts and communication rather than the helping professions.

d.had a degree in the arts and communication rather than the helping professions.

Could it be that Haley viewed his lack of formal training in the counseling field as an advantage? Possibly! While at the Philadelphia Child Guidance Clinic he and pioneer Salvador Minuchin trained people with virtually no background in psychotherapeutic intervention. Since these individuals did not harbor preconceived notions of what therapy should or should not be they were seemingly more open to innovative ideas.


A couple tells a therapist using strategic family therapy that they have a quarrel at least once every evening. The therapist says, “Between now and the next time I see you I want you to have a serious quarrel at least twice every evening.” This is an example of
a.relabeling, which is commonly used in this form of therapy.
b.reframing, which is commonly used in this form of therapy.
c.prescribing the symptom.
d.a directive that is not paradoxical or a double bind.

c.prescribing the symptom.

Choices “a” and “b” mean roughly the same thing and are used by Haley and his followers. Choice “d” stands incorrect since prescribing the symptom is a paradoxical strategy.


In strategic family counseling the person with the power in the family
a.has the authority to make rules and enforce them.
b.is usually extremely aggressive.
c.is usually not willing to follow a family therapist’s prescriptions or directives.
d.is the one who talks the most.

a.has the authority to make rules and enforce them.

Haley believes you enhance the power of a family member within the context of therapy by speaking to him or her first during the initial session of therapy.


Psychoanalytic practitioners do not attack symptoms directly. Strategic therapy
a.does not attack the symptoms directly either.
b.is pragmatic and often focuses on abating symptoms.
c.does not take a position on whether a counselor should attempt to ameliorate symptoms or not.
d.takes the position that if you can change each family member’s unconscious, then symptoms will gradually disappear.

b.is pragmatic and often focuses on abating symptoms.

Haley’s therapy is solution/symptom focused and very action oriented.


Madanes advocates pretend techniques that are somewhat paradoxical. An example might be
a.a child who has panic attacks pretends he has a mental bullhorn in his head and shouts “stop.”
b.a child who has panic attacks pretends in his mind that a therapist is counseling him.
c.a child who has panic attacks pretends his dad is a therapist during the actual family therapy session.
d.a child who has panic attacks pretends to have one during the session and the parents pretend to help him.

d.a child who has panic attacks pretends to have one during the session and the parents pretend to help him.

In the pretending, the family enacts a make-believe scenario of the problem. Most experts maintain that the pretend technique is more gentle and less confrontational than traditional paradoxical interventions.


A strategic family therapist says to a family, “I don’t know what else you can do to stop the bickering and fighting in your house.” This is an example of
a.restraining.
b.quid pro quo.
c.pretending.
d.interpretation.

a.restraining.

In restraining a therapist may warn the family or individual about the negative consequences of change. The counselor might tell the family to take it very slow or expect a relapse. Restraining helps overcome resistance by suggesting that it might be best if the family does not change!

A family counselor treats an Asian-American family exactly like he treats the Hispanic families in his caseload. He also imposes values from his own culture on them. This counselor has been described in the literature as


a.culturally sensitive.
b.lacking cultural sensitivity.
c.culturally encapsulated, a term suggested by counseling pioneer Gilbert Wrenn.
d.b and c. 

d.b and c.

Cultural encapsulation results in a counselor imposing goals from his or her own culture on people from another culture. This is a no-no in counseling. Counselors who treat all families the same ignore key cultural differences.


Which statement is true of African-American families?
a.They are the largest minority in the United States.
b.Fewer African Americans are getting married than at any time in history and out-of wedlock births account for two out of three first births to African-American women under the age of 35.
c.African Americans are less likely to be concerned about gender roles (e.g., men and women can cook meals or work outside of the home).
d.b and c.

d.b and c.

Choice “a” is false since as of this writing African Americans constitute the second largest minority. Hispanics constitute the largest minority group.


When working with an African-American family the best approach would probably be
a.Bowen’s family therapy; Minuchin’s structural family therapy; or Jay Haley’s strategic family therapy.
b.cognitive family therapy.
c.Ackerman’s psychoanalytic approach to family therapy.
d.a strict reality therapy approach based on the work of psychiatrist William Glasser.

a.Bowen’s family therapy; Minuchin’s structural family therapy; or Jay Haley’s strategic family therapy.

A high percentage of African-American families do not seek out professional treatment because they often rely on the extended family and the church for support and guidance. This is viewed as a strength. When family counseling is utilized, problem-focused, brief, or multigenerational approaches mentioned in the first choice seem to fare best.


When counseling Asian-American families the best approach would most likely be
a.Nathan Ackerman’s psychoanalytic approach.
b.behavioral family therapy.
c.solution focused/problem focused modalities.
d.a, b, and c.

c.solution focused/problem focused modalities.

Asian-American families also tend to use community resources on their own once the therapist has given them the appropriate information.


Which statement is true of Hispanic families?
a.They have a high unemployment rate, often live in poverty, and rarely earn high school diplomas or college degrees.
b.They have higher than average incomes but usually don’t finish high school or college.
c.They have college degrees, but still generally live in poverty.
d.They prefer long-term treatment in therapy.

a.They have a high unemployment rate, often live in poverty, and rarely earn high school diplomas or college degrees.

In general, Hispanic families have less education than non-Hispanics; have twice as many people living below the poverty level as non-Hispanics; and have a higher unemployment rate than non-Hispanics. Let me address choice “d.” In a high percentage of the cases Hispanic clients expect mental health treatment to mimic the treatment they receive from their medical doctors. Short-term behavioral family therapy or structural approaches appear to work well.


Which statement is true regarding Native-American families?
a.They are a very diverse group as they belong to over 500 state-recognized tribes.
b.Extended family and the tribe are very significant.
c.A high percentage of children have been placed in foster care homes, residential facilities, or adoption homes that are non-Native American.
d.All of the above are true.

d.All of the above are true.

Most theorists agree that the result of choices “a,” “b,” and “c” (all true, by the way) has been identity confusion.


The statement, “Native Americans have a problem with alcoholism and suicide,” is
a.false.
b.true as far as alcoholism is concerned, however, false where suicide is concerned.
c.true.
d.true regarding the suicide rate, however, false regarding their use of alcoholic beverages.

c.true.

Since the statement is true this creates issues with suicide bereavement (people mourning a suicide are known as “survivors of suicide”), fetal alcoholism, and cirrhosis of the liver.


Murray Bowen is known for his work in intergenerational family therapy. When Bowen refers to triangulation he means
a.that most people have three ego states (i.e., the Parent, the Adult, and the Child) in their personality.
b.that most people have a personality structure composed of the id, the ego, and the superego.
c.when a dyad (i.e., two individuals) is under stress a third person is recruited to help stabilize the difficulty between the original dyad. This could even be a child placed in the middle of the conflict.
d.therapy has three distinct phases.

c.when a dyad (i.e., two individuals) is under stress a third person is recruited to help stabilize the difficulty between the original dyad. This could even be a child placed in the middle of the conflict.

Choice “a” is postulated via transactional analysis while choice “b” is the darling of the Freudians. Choice “c” is the correct answer. Unfortunately, the ploy usually makes the situation between the original pair worse!


One of the primary goals of Bowen’s intergenerational family therapy is differentiation. Differentiation is
a.the extent that one can separate one’s intellect from one’s emotional self.
b.the extent that one is different from one’s peers.
c.the extent that one is different from one’s childhood.
d.the same as fusion.

a.the extent that one can separate one’s intellect from one’s emotional self.

Did you mark choice “d”? If so, you’d be going back a space or two if this were a board game since fusion is the direct opposite of differentiation. It occurs when the intellectual and emotional aspects of the personality merge. A person who does not possess differentiation does not have a clear sense of the self and others.


Bowen popularized a three-generational pictorial diagram as a therapy tool. This is known as
a.an histogram.
b.a sociogram.
c.a genogram.
d.family sculpting.

c.a genogram.

A genogram is a family tree of sorts that relies on lines, words, and geometric figures (e.g., squares for males, circles for females, horizontal lines for marriages, and vertical lines for children). If you’ve ever studied electronics you will note that a genogram looks a bit like a schematic. Bowen suggested that the genogram should depict three or more generations.


An important technique in structural family therapy is joining. Which statement most accurately depicts this intervention?
a.The therapist meets, greets, and attempts to bond with the family. The therapist will use language similar to that of the family and mimesis which means that he or she will mimic communication patterns.
b.The therapist is professional but distant.
c.The therapist joins the family and sympathizes with their difficulties.
d.Joining is used during the final session of therapy.

a.The therapist meets, greets, and attempts to bond with the family. The therapist will use language similar to that of the family and mimesis which means that he or she will mimic communication patterns.

Joining occurs during the initial session to boost the family’s confidence in the treatment process and reduce resistance. In subsequent sessions the therapist will challenge the dysfunctional communication patterns and the structure of the family.

A family is seeing a structural family therapist because there is a huge argument every time the subject of the 16-year-old daughter’s boyfriend comes up. The therapist says, “Okay, I want you to play like you are at home and act out precisely what transpires when the subject of your daughter’s boyfriend is mentioned.” The structural family therapist is using a technique called


a.joining.
b.reframing (defined as an alternative way of describing or perceiving an event).
c.enactment.
c.cognitive disputation. 

c.enactment.

Enactment is a strategy that allows the counselor to see an instant replay, if you will, of what genuinely transpires in the family. Although “c” is the correct answer here structural therapists do employ refraining and relabeling discussed in earlier questions


When a structural therapist uses the term boundaries he or she really means
a.the limits of the human mind.
b.the limits of behavior in the family.
c.the separation of the family members from their family of origin.
d.the physical and psychological entities that separate individuals and subsystems from others in the family.

d.the physical and psychological entities that separate individuals and subsystems from others in the family.

When structural therapists attempt to help the family create healthy boundaries it is known as changing boundaries or the boundary marking technique. In this technique the family is seating is often altered and family members are placed at a different distance from each other.


In Minuchin’s structural approach, clear boundaries are
a.pathological.
b.rigid.
c.also called diffuse boundaries.
d.ideal—firm yet flexible.

d.ideal—firm yet flexible.

Clear boundaries are considered healthy. When boundaries are clear persons in the family are supported and nurtured, but each has the freedom to be his or her own person (i.e., individuate.


A woman is having difficulties at her place of employment. Her husband turns to her in a session and says, “You’re on your own, I’ve got my own problems.” A structural family therapist would assert that the boundaries between this couple are
a.rigid.
b.clear.
c.diffuse.
d.a combination of a and c.

a.rigid.

Rigid boundaries are characterized by individuals or subsystems being disengaged. What will the wife do in this situation? Well, according to this theory she will seek support outside of the family system.


Minuchin would often mimic the family’s style. This is known as
a.cognitive disputation.
b.the structural map.
c.permeable boundaries.
d.none of the above.

d.none of the above.

Minuchin did rely on a so-called structural map with symbols to diagram the structure of the family, but of course, choice “b” is not the correct answer. Choice “d” is correct. The correct term is mimesis and it implies that the therapist copies the family’s style. This helps the therapist join the family and helps the family accept him or her as a helper.


A family member who is emotionally distant is
a.disengaged.
b.enmeshed.
c.an example of equifinality.
d.a placater.

a.disengaged.

Disengagement is often defined as an isolated lack of connectedness between family members.


During the course of a family session you discover that a man and his 14-year-old boy are putting pressure on mom to quit her job. Mom very much likes her work. In Haley’s theory this set of dynamics would be called
a.reframing.
b.equifinality.
c.the perverse triangle.
d.paradox.

c.the perverse triangle.

The perverse triangle is a situation when two members who are at different levels of the family hierarchy (usually a coalition between parent and a child) team up against another family member. The alliance between the parent and the child may be overt or covert. In any event, the alliance against the other parent undermines his or her power and authority.


_______ was a pioneer in the early history of family therapy.
a.Carl Jung.
b.David Wechsler.
c.Alfred Adler.
d.Franz Anton Mesmer.

c.Alfred Adler.

Adler opened over 30 child guidance clinics in Vienna in the 1920s that were later eliminated by the Nazi Party in 1934. These clinics would often perform open forum therapy in which Adler worked with the family as well as the open forum audience.


Which therapist could best be described as atheoretical?
a.Jay Haley.
b.Carl Whitaker.
c.Alfred Adler.
d.Nathan Ackerman.

b.Carl Whitaker.

Whitaker asserted that theory is often used as an excuse to keep therapists emotionally distant from the family. Whitaker promoted “craziness” (not a typo!) and creativity of family members.


Solution-Oriented therapy as practiced by William O’Hanlon, Insoo Kim Berg, Steve de Shazer, and Michelle Weiner Davis focuses primarily on
a.the past.
b.the present.
c.the future.
d.dream analysis.

c.the future.

This approach puts little or no emphasis on understanding the problem. The therapist’s verbalizations center on the future. The therapist coformulates a plan of action with the client or family. There may be more than one appropriate course of action.


The term skeleton keys as used in Steve de Shazer’s brief solution-focused therapy (BSFT) indicates
a.a standard or stock intervention that will work for numerous problems.
b.a technique where the client goes home to see his or her family of origin.
c.a technique that works for one specific problem, but usually will not work with other difficulties.
d.a technique in which the therapist hands the client or clients a sheet of paper with a compliment on it.

a.a standard or stock intervention that will work for numerous problems.

Choice “d,” although it is not the correct answer, is a de Shazer technique that has been dubbed simply as a compliment. When using a similar technique known as past successes the therapist may also compliment past successes without specifically relating them to the current obstacles. Brief therapy is sometimes abbreviated as BT.


One criticism of using cognitive-behavioral methods like REBT with families or individuals in multicultural counseling would be
a.that the theory is not intended to be used with diverse populations.
b.the theory suggests that the therapist must have ethnic or racial ties with the client in order for efficacious treatment to occur.
c.that it ignores present moment problems.
d.that the cognitive disputation could go against cultural messages.

d.that the cognitive disputation could go against cultural messages.

Another criticism is that Ellis views dependency as unhealthy and some cultures see interdependence as a positive attribute.


Pick the most accurate statement.
a.Brief solution-oriented therapy requires the use of a oneway mirror with a treatment team behind the mirror.
b.Brief solution-oriented therapy does not utilize a treatment team behind a one-way mirror.
c.Brief solution-oriented therapy sometimes uses a treatment team behind a one-way mirror, nevertheless, it is not required.
d.Brief solution-oriented therapy does not utilize paradoxical interventions.

c.Brief solution-oriented therapy sometimes uses a treatment team behind a one-way mirror, nevertheless, it is not required.

Brief solution-oriented strategic therapy often relies on paradox; hence, choice “d” is incorrect. On brief strategic/family therapy questions on your exam, the term ecosystems refers to the fact that larger systems often impact client and family functioning (e.g., the schools, church, or health care system). An ecosystemic approach always takes these larger systems into account.


A researcher takes a group of clients and gives them a depression inventory. He then provides each client with two sessions of brief solution-oriented therapy and gives them the same depression inventory. A t test is used to compare the two sets of scores on the same people (i.e., the before and after measures of depression). This would be
a.a between-groups design.
b.a correlation coefficient.
c.a related measures within-subject design.
d.survey research.

c.a related measures within-subject design.

In the within-subjects design, each subject acts as his or her own control. The between-groups design (which relies on separate people in the control and experimental groups) is a much more popular form of research. When a single group is used in research or two groups that are not equivalent your exam will probably refer to this situation as a preexperimental design.


A time-series design is a quasi-experimental design
a.that utilizes two randomly chosen groups; a control group and an experimental group.
b.that relies on multiple observations of the dependent variable (i.e., the thing you are measuring) before and after the treatment occurs.
c.a and b.
d.is not depicted by any of the answers above.

b.that relies on multiple observations of the dependent variable (i.e., the thing you are measuring) before and after the treatment occurs.

Choice “a” is incorrect since two randomly chosen groups would constitute a true experiment. Using our abbreviations this design would look something like this: O1, O2, O3, X, O4, O5,O6.


The Solomon four-group is considered a true experimental design since each group is chosen via a random sample. When using this design
a.all groups receive a pretest.
b.there is no pretest.
c.one control group receives a pre-test and one experimental group receives a pretest; the other control group and experimental group do not.
d.there is no posttest.

c.one control group receives a pre-test and one experimental group receives a pretest; the other control group and experimental group do not.

In this design one pair of control/experimental groups receives a pretest while the other pair does not. This design helps weed out the impact of a pretest.


Which group would most likely avoid eye contact with the counselor and benefit from assertiveness training?
a.African/Black Americans.
b.Asian Americans.
c.European Americans.
d.All of the above.

b.Asian Americans.

The best answer is choice “b”; however, many African Americans (or perhaps African/Black Americans on your exam) seem to avoid eye contact while listening but not while speaking.


The newest career theory would be
a.constructivist and cognitive approaches.
b.the trait-and-factor approach.
c.the developmental and psychoanalytic approaches.
d.the transactional analysis approach.

a.constructivist and cognitive approaches.

Career experts wonder if traditional theories are applicable now since the majority were based on research using White middleclass males, which is hardly representative of the work market today that includes more people of color, a large number of women and teens, and more persons from lower socioeconomic classes


Most experts believe that the number of multigenerational families with a child, a parent, and a grandparent will
a.decrease.
b.increase.
c.remain static.
d.will continue to go up and down on a fairly regular basis.

b.increase.

The number of families of this ilk nearly doubled between 1980 and 1990. When the economy goes into a recession and young adults can’t afford to live on their own they often live with their family. In addition, as more people live longer, the number will go up since many of the older folks are incapable of caring for themselves. And just in case your exam asks, the number of single adults in the United States is also increasing.


A question on the NCE asks you to compute the coefficient of determination. You are given a correlation coefficient of .70. How would you mathematically accomplish this task?
a.You would subtract .70 from a perfect correlation of 1.00.
b.You would multiply the mean of the population by .70.
c.You would add .70 to a perfect correlation of 1.00.
d.You would square the .70.

d.You would square the .70.

The coefficient of determination is computed by squaring the correlation coefficient. Thus, in this case the variance would be 49%.


A correlation coefficient between variables X and Y is .60. If we square this figure we now have the coefficient of determination or true common variance of 36%. What is the coefficient of nondetermination that shows unique rather than common variance?
a.There is no such concept.
b.You would subtract 36 from 100.

c.It would still be 36%.
d.It would be 64%.

d.It would be 64%.

You subtract the coefficient of determination from 100.


Krumboltz’s social learning theory is sometimes referred to as a cognitive theory because it emphasizes beliefs that clients have about themselves as well as the world of work. When Krumboltz speaks of self-observation generalizations he really means
a.generalizations regarding a given occupation and how successful the client would be in the occupation.
b.Pavlov’s principle of stimulus generalization.
c.Skinner’s principle of operant conditioning.
d.that in career counseling your primary concern is the manner in which people view themselves and their ability to perform in an occupation.

d.that in career counseling your primary concern is the manner in which people view themselves and their ability to perform in an occupation.

Choice “a,” though incorrect, is what Krumboltz calls worldview generalizations that are also important when counseling a client.


SCCT stands for
a.social-cognitive career theory.
b.social-cognitive family therapy.
c.self-control career theory.
d.self-contained career therapy.

a.social-cognitive career theory.

Social-cognitive career theory asserts that self-efficacy beliefs can influence one’s career decisions. A woman, for example, may have very good math skills, nevertheless, she might not consider the field due to the belief that women are not as proficient in math as men. Self-efficacy really deals with the personal question of, “Can I really do this and what will happen if I try to do this?”


The psychometrician calls you to tell you that she has another student who has an IQ that falls near the 84th percentile. This student’s IQ
a.is somewhere in the gifted range, say 140.
b.is most likely near 105.
c.is approximately 115.
d.is between 75 and 80.

c.is approximately 115.

Here again, take a look at the normal curve. The 84th percentile is about a standard deviation above the mean. A standard deviation above the mean is roughly 15 IQ points above the mean or 100 plus 15 or an IQ of 115. Again I ask you, why do you think we call it the advanced section?


The mean score on a new counseling exam is 65. The standard deviation is 15. Tanja scored a 35. This tells us that
a.she had a z score of +1.
b.she had a z score of -1.
c.she had a t score of 40.
d.she had a z score of -2.0.

d.she had a z score of -2.0.

The z score is the same as the standard deviation. In this case Tanja scored two standard deviations below the mean.


Which theorist would most likely assert that EQ is more important than IQ?
a.David Wechsler.
b.Alfred Binet.
c.Charles Spearman.
d.Daniel Goleman.

d.Daniel Goleman.

EQ incidentally stands for emotional intelligence. EQ would encompass traits such as empathy, impulse control, motivation, and the ability to love. According to Daniel Goleman in his popular book Emotional Intelligence: Why It Can Matter More Than IQ it is EQ rather than IQ that determines success.

Pick the most accurate statement


a.behavior therapies based on classical conditioning are used primarily with clients who have bipolar disorder. Lithium is no longer used.
b.Behavior therapies based on classical conditioning are much more effective than CBT when treating mood disorders.
c.Behavior therapies based on classical conditioning are commonly used to treat phobias, but are also utilized for clients with obsessive-compulsive disorders or OCD.
d.Behavior therapy is never based on classical conditioning 

c.Behavior therapies based on classical conditioning are commonly used to treat phobias, but are also utilized for clients with obsessive-compulsive disorders or OCD.

One of the most popular forms of behavior therapy based on classical conditioning, Wolpe’s systematic desensitization, is an excellent therapy for phobic clients in individual and group therapy and it has its roots in Pavlov’s classical conditioning. In terms of choice “a” psychiatrists and other physicians are still prescribing lithium for bi-polar disorder. Clients must be monitored since high dosages can lead to medical problems or even death.


Approximately 40% of all elementary schools have shortened recess or student playtime. Counselors
a.are excited about this change because U.S. children are behind other countries academically and thus need more study time.
b.believe the change will actually have little or no impact on the children.
c.are concerned because some research indicates that recess can have a positive impact since children are less fidgety on days when they have recess; especially if they are hyperactive.
d.are not concerned as boys have better concentration on days when they do not have recess.

c.are concerned because some research indicates that recess can have a positive impact since children are less fidgety on days when they have recess; especially if they are hyperactive.

Choice “d” is patently false. Boys showed less concentration on days when normal recess was delayed. Choice “c” stands correct as research indicates that fourth graders were less fidgety on days with recess playtime. Good attention requires periodic novelty.


The new ACA 2005 Code of Ethics forbids sexual or romantic counselor–client interactions or relationships with current clients, as did the old code. The old 1995 Code stipulated that a counselor would need to wait two years after termination before entering into a romantic relationship with a former client. The new regulations
a.are virtually identical in this area.
b.changed 2 years to 10 years.
c.changed 2 years to 5 years.
d.changed 2 years to just 1 year.

c.changed 2 years to 5 years.

This is a key change! It also applies to romantic relationships with a client’s family members or romantic partners. Expect to see this question coming to a professional credentialing exam near you! Again, I cannot overemphasize this point: Read the new 2005 ACA Code prior to taking your exam.


You are counseling a well-known celebrity who dies. According to the new 2005 ACA Ethical Code
a.Confidentially exists even after she dies.
b.Confidentiality does not exist after death for any professional helper. Princess Diana’s therapist was on television talking about Princess Di’s eating disorder immediately after her death.
c.The ethics state “a counselor has no obligation to uphold confidentiality after a client’s death.”
d.The counselor is given no direction since this issue is not addressed in the guidelines.

a.Confidentially exists even after she dies.

The ACA Code promotes the protection of deceased clients.


Over 7,000 ACA members are now in private practice. The consensus among experts is that
a.most private practitioners will not need to deal with managed care.
b.managed care companies are becoming increasingly difficult to deal with.
c.managed care companies are becoming easier to work with.
d.ACA ethics now prohibit practitioners from being on managed care panels.

c.managed care companies are becoming easier to work with.

Choice “c” best describes the current situation. Thank god for small favors! I could share a few personal horror stories from the early 1990s when I was in private practice, but you’ve got more important things to remember! So far as choice “a” is concerned, some private practices are now nearly 100% managed care driven.


Matt was diagnosed with somatization disorder which falls under the category of somatoform disorders. It safe to say that
a.Matt is under 21.
b.Matt has never had a physical exam.
c.His symptoms have lasted over six months and his condition manifested itself prior to age 30.
d.Matt’s only complaint is his back pain.

c.His symptoms have lasted over six months and his condition manifested itself prior to age 30.

The diagnostic criteria for somatization disorder include multiple somatic complaints that have lasted for several years. Moreover, a physical exam has not turned up a physical cause (that knocks out choice “b”). At least four symptoms are evident and the symptoms last for at least six months. Finally, the onset must be prior to age 30.


You are seeing a client who is extremely concerned about her body weight and shape. She vomits to keep her weight down, nevertheless, she does not engage in binge eating. The most appropriate diagnosis would be
a.anorexia.
b.bulimia.
c.gender identity disorder.
d.eating disorder NOS.

d.eating disorder NOS.

Since this disorder does not fit neatly into any other eating disorder category your diagnosis would be eating disorder NOS or eating disorder “not otherwise specified.”


A hermaphrodite is
a.now referred to as an intersex person.
b.always gay.
c.always homosexual.
d.also called a cross-dresser.

a.now referred to as an intersex person.

An intersex individual has a condition called “intersexuality” (in the past known as a hermaphrodite) and has male and female genitalia. Choice “d” a cross-dresser wears clothes generally worn by the opposite sex and has been called a transvestite in some of the literature. Choices “b” and “c” are incorrect inasmuch as intersex individuals, or cross-dressers for that matter, are not exclusively heterosexual or homosexual.


Gay men and women
a.primarily live the gay or lesbian lifestyle.
b.basically have the same range of gender role behaviors as do male and female heterosexuals.
c.cannot be characterized in terms of lifestyle due to a distinct lack of research.
d.are always transgendered.

b.basically have the same range of gender role behaviors as do male and female heterosexuals.

Choice “a” is way off base: There is no single gay, lesbian, bisexual lifestyle! Choice “d” transgender is used to describe a person who does not identify with his or her birth sex. Transsexuals are generally regarded as being in a separate category from transgendered individuals because transsexuals resort to the use of hormones and plastic surgery in order to better express their identity.


Warren needs to conduct a study. His supervisor wants him to use a parametric inferential statistic. This means that
a.he will need to use random sampling and the distribution is normal.
b.he will need to use a convenience sample or a volunteer sample.
c.his distribution will be positively skewed.
d.his distribution will be bimodal.

a.he will need to use random sampling and the distribution is normal.

By definition, parametric statistics are used when the distribution is normal (i.e., the mean, the median, and the mode are the same), and random sampling has been utilized. Convenience samples and volunteer samples are not picked randomly. Moreover, a bimodal or multimodal curve is not the same as a bellshaped normal curve.


A career counselor who relies on the constructivist viewpoint would emphasize that
a.unconscious conflicts influence career decisions.
b.An individual’s career choice is influenced by his or her attempt to make meaning out of the world of work.
c.Most career counselors do not give enough career inventories.
d.SCCT is the best theory.

b.An individual’s career choice is influenced by his or her attempt to make meaning out of the world of work.

SCCT is the abbreviation of social cognitive career theory.


As a private practice counselor your ______ would be most
important in terms of filing claims.
a.graduate transcript.
b.undergraduate and graduate transcript.
c.NCC provider number.
d.NPI number.

d.NPI number.

The National Provider Identifier (NPI) number would be required to file claims electronically or even by mail. HIPAA rules stipulate that the NPI is your standard unique identifier as a health care provider.

You have impeccable training and experience as a counseling supervisor. Now your brother finishes his master’s degree in counseling and wants you to supervise him. According to ACA ethics you should


a.accept him as a supervisee since it will be beneficial to him.
b.cosupervise him with another colleague.
c.refer him to a trusted colleague trained in supervision who is willing to take your brother.
d.supervise him if it is for licensing, but not if it is for NCC. 

c.refer him to a trusted colleague trained in supervision who is willing to take your brother.

To quote ACA guidelines, “Counseling supervisors avoid accepting close relatives, romantic partners, or friends as supervisees.” Case closed!

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