MFT National Exam cheat sheet

Circular causality: behavior is explained as a recursive A-to-B-to-A loop; the symptom is located in the interactional pattern rather than inside one identified patient.

Negative feedback (deviation-reducing) restores the system's prior equilibrium and maintains homeostasis; positive feedback (deviation-amplifying) escalates change or conflict.

First-order change alters behavior within existing system rules; second-order change alters the rules or structure of the system itself.

Triangulation: tension in a dyad is detoured through a third person, which stabilizes the dyad while recruiting the third party into the conflict.

Structural therapy (Minuchin): constructs are boundaries (clear, diffuse, rigid), hierarchy, alignment, and enmeshment vs. disengagement; techniques are joining, enactment, unbalancing, and restructuring.

MRI/strategic model: identify the problem-maintaining sequence, reframe it, and assign directives; paradoxical interventions such as prescribing the symptom require informed consent and careful case selection.

Milan systemic model: neutrality, circular questioning, positive connotation of the symptom, and hypotheses tested by a reflecting team.

Solution-focused (de Shazer, Berg) and narrative (White, Epston) models: exceptions, miracle question, and scaling; externalizing the problem, unique outcomes, and re-authoring the dominant story.

Assessment in systemic therapy is continuous; a systemic hypothesis is a provisional explanation of the problem-maintaining pattern that must be revised as new data emerge.

A genogram covers at least three generations and maps household structure, major events, illness, occupations, and relationship patterns to generate hypotheses.

Olson's Circumplex Model plots cohesion and flexibility (plus communication); balanced levels on both dimensions are associated with healthier functioning than extreme levels, and FACES IV measures these dimensions.

The McMaster model's Family Assessment Device measures problem solving, communication, roles, affective responsiveness, affective involvement, and behavior control.

The Dyadic Adjustment Scale (Spanier, 1976; 32 items) is a widely used self-report measure of global relationship satisfaction and distress.

DSM-5-TR (published March 2022): major depressive disorder requires at least 5 of 9 symptoms for at least 2 weeks, including depressed mood or anhedonia; generalized anxiety disorder requires 6 months of excessive worry; PTSD requires symptoms in 4 clusters for more than 1 month.

Relational problems that are not mental disorders are coded as Z-codes, e.g., Z63.0 relationship distress with spouse or intimate partner, Z62.820 parent-child relational problem, Z62.898 child affected by parental relationship distress.

Rule out medical conditions, substance effects, and culturally normative behavior before diagnosing; the DSM-5-TR Cultural Formulation Interview supports this, and suicide risk should be asked about directly and documented with a safety plan.

Treatment plans document the relational problem, measurable goals, chosen model and interventions, session frequency and length, participant roles, and criteria for review and termination.

Interventions are matched to the assessed problem-maintaining pattern: pursue-withdraw cycles indicate EFT or IBCT; coercive family interactions indicate structural or behavioral parent training.

Family-based treatments with replicated randomized trial support include multisystemic therapy, functional family therapy, brief strategic family therapy, multidimensional family therapy, and trauma-focused CBT for children.

Session one: join with each member, redefine the problem in relational terms, negotiate goals, complete informed consent, and disclose the no-secrets policy in writing for couple and family work.

Sequence treatment to de-escalate conflict before addressing content; use in-session enactments and block destructive process rather than lecturing the family.

Do not conduct conjoint sessions when there is ongoing violence or coercion, untreated severe substance use, active psychosis, or an undisclosed secret that renders joint sessions unsafe or unworkable.

Outcome measurement at each session (e.g., ORS/SRS, PHQ-9, DAS) converts treatment planning into a data-driven decision rule: no reliable change triggers reformulation.

Technology-assisted services require verifying client identity and physical location, licensure jurisdiction, local emergency resources, and use of a HIPAA-compliant platform.

Progress is judged against baseline using standardized measures plus clinical observation; deterioration or no reliable change signals the need to revisit the hypothesis, model, or therapeutic fit.

Feedback-informed treatment: routinely collecting and discussing client feedback improves outcomes, with the largest benefit for clients who are off-track.

A decision rule of roughly 6 to 8 sessions with no measurable improvement warrants consultation, reformulation, or referral.

Termination criteria: goals met, gains maintained across settings, relapse-prevention skills in place, and reduced need for the therapeutic relationship.

Planned termination includes early discussion, review of gains, consolidation of skills, anticipation of triggers, a written relapse-prevention plan, and optional booster sessions.

Unplanned termination and dropout are common in routine practice; the clinician documents outreach attempts, offers re-engagement, and provides referrals.

Termination summary documents presenting problem, course of treatment, outcome, status at termination, referrals, and aftercare recommendations.

The AAMFT Code of Ethics (effective January 1, 2015) organizes standards under headings including responsibility to clients, confidentiality, professional competence and integrity, students and supervisees, research participants, the profession, financial arrangements, and advertising.

Informed consent at intake covers the nature, risks, and benefits of therapy; confidentiality and its limits; fees and payment; record policies; third-party involvement; and the right to withdraw.

Confidentiality exceptions: suspected child, elder, or dependent adult abuse; imminent danger to self or identifiable others; court order or client authorization; HIPAA permits disclosure to prevent a serious and imminent threat (45 CFR 164.512(j)).

In couple and family therapy the unit is the client; a written no-secrets policy must be disclosed at intake, and the therapist may not later serve as custody evaluator for the same family.

HIPAA: psychotherapy notes require a separate authorization for release, the Notice of Privacy Practices must be provided, the minimum-necessary standard applies, and breach notification occurs within 60 days of discovery.

AAMFT prohibits sexual intimacy with current clients and with their partners or family members; with former clients and their family members it is prohibited for at least two years after termination.

Nonprofessional (multiple) relationships with clients or their close contacts are undertaken only when the risk is documented and unlikely to impair clinical judgment or exploit the client.

Clinicians practice within their scope of competence, obtaining supervision or consultation or referring when a case exceeds training and supervised experience.

Record retention typically follows state law, commonly 7 years for adults and longer for minors; records are released only with written authorization or legal mandate.

Efficacy research uses controlled designs such as randomized controlled trials and prioritizes internal validity; effectiveness research tests treatments in routine practice and prioritizes generalizability.

Lambert's common-factors estimates: about 40% client/extratherapeutic factors, 30% therapeutic relationship, 15% expectancy/placebo, and 15% technique.

Dose-response findings (Howard et al., 1986): roughly 50% of clients show improvement by 8 sessions and about 75% by 26 sessions.

Meta-analytic evidence indicates couple and family therapy produces moderate-to-large effects comparable to individual therapy for many presenting problems, often with lower dropout and cost.

Empirically supported treatment status requires multiple randomized trials conducted by independent research teams; it does not establish that other models are ineffective.

The alliance-outcome association is robust across models, and rupture-and-repair processes are predictive of outcome in process research.

Measurement-based care research shows routine outcome monitoring improves outcomes and reduces deterioration, particularly when clinicians act on negative feedback alerts.