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Free National MFT Exam Practice Questions

10 free, exam-style National Marriage and Family Therapy Examination (National MFT Exam) practice questions with answers and explanations. No signup required. Work through them below, then take the full free National MFT Exam practice test to study every exam domain.

Question 1

A couple has been in Emotionally Focused Therapy for four months. The husband, who consistently withdrew from conflict, has become noticeably more engaged and accessible in recent sessions. His wife - who had relentlessly pursued him with criticism - has grown quiet over the last two sessions and said, 'I'm scared to ask him to be there for me. What if he pulls away again?' The therapist recognizes this as a pivotal clinical moment. According to EFT's nine-step model, the wife's shift MOST likely represents:

  1. A rupture in the therapeutic alliance that must be repaired before progress can continue
  2. The couple entering the consolidation stage of treatment
  3. The beginning of blamer softening in the pursuing partner
  4. A return to the negative interaction cycle expressed in a new form
Show answer & explanation

Correct answer: C - The beginning of blamer softening in the pursuing partner

Question 2

A family enters therapy because their teenage son's explosive outbursts have made home life unmanageable. After eight sessions, his behavior has improved significantly. However, the parents now report escalating marital conflict, and their 11-year-old daughter has begun having nightly stomachaches and refusing to go to school. A systemic therapist would MOST likely understand this pattern as:

  1. The family system redistributing tension to maintain its equilibrium as the original symptom resolves
  2. New psychiatric diagnoses emerging in other family members that had been masked by the intensity of the son's presenting problem
  3. Developmental stressors in the daughter that coincidentally align with the timing of treatment
  4. Therapeutic progress destabilizing the family's existing attachment bonds
Show answer & explanation

Correct answer: A - The family system redistributing tension to maintain its equilibrium as the original symptom resolves

Question 3

A 42-year-old man presents for therapy five weeks after being unexpectedly laid off. He reports persistent sadness, anhedonia, fatigue, hypersomnia, feelings of worthlessness, and poor concentration every day for the past three weeks. His symptoms began within days of the job loss. He denies suicidal ideation. Which DSM-5-TR diagnosis is MOST appropriate?

  1. Adjustment Disorder with Depressed Mood
  2. Major Depressive Disorder
  3. Persistent Depressive Disorder
  4. Occupational Problem (Z56.9)
Show answer & explanation

Correct answer: B - Major Depressive Disorder

Question 4

A therapist working with a 12-year-old girl referred for 'persistent lying' says: 'It sounds like Sneakiness has been following you around for a while. When Sneakiness shows up, what does it promise you? And can you remember a time when you saw it coming and told it no?' The therapeutic technique being used is BEST described as:

  1. Prescribing the symptom to reduce its power through paradox
  2. Externalizing the problem to create space for the client's preferred identity
  3. Exploring exceptions to the problem in order to build solution-focused momentum
  4. Challenging irrational self-attributions through cognitive restructuring
Show answer & explanation

Correct answer: B - Externalizing the problem to create space for the client's preferred identity

Question 5

The parents of a 16-year-old girl recently diagnosed with Anorexia Nervosa ask the therapist which treatment approach has the strongest research base for adolescent AN. The therapist should recommend:

  1. Dialectical Behavior Therapy, which targets the emotional dysregulation and distress intolerance that commonly underlie restrictive eating behaviors
  2. Individual Cognitive-Behavioral Therapy targeting distorted body image and cognitive rigidity
  3. Family-Based Treatment, in which parents temporarily take charge of refeeding and weight restoration
  4. Motivational Interviewing to build the adolescent's own readiness for behavioral change
Show answer & explanation

Correct answer: C - Family-Based Treatment, in which parents temporarily take charge of refeeding and weight restoration

Question 6

A therapist is conducting a suicide risk assessment and notes the following about a client: hopelessness scores in the severe range, a recent divorce filing, a diagnosis of Bipolar I Disorder, and two prior suicide attempts - the most recent 18 months ago. In weighing these factors, which single factor carries the GREATEST empirical weight in predicting completed suicide?

  1. Diagnosis of Bipolar I Disorder
  2. Severe hopelessness
  3. Recent divorce and associated losses
  4. Two previous suicide attempts
Show answer & explanation

Correct answer: D - Two previous suicide attempts

Question 7

Before a first couples session, an MFT conducts a brief individual check-in with the wife. She privately discloses that her husband monitors her phone and emails, controls all household finances, has threatened to report her to immigration authorities if she 'causes trouble,' and has pushed her twice in the past year. The MOST appropriate clinical response is:

  1. Proceed with couples therapy and identify the power imbalance as the primary treatment focus
  2. Begin with separate individual sessions for both partners before attempting conjoint work
  3. Conduct an individual safety assessment with the wife and recognize that conjoint therapy is contraindicated
  4. Refer the couple to a structured, evidence-based program specifically designed for couples who are experiencing high levels of conflict and communication breakdown
Show answer & explanation

Correct answer: C - Conduct an individual safety assessment with the wife and recognize that conjoint therapy is contraindicated

Question 8

An MFT in private practice receives a subpoena from an opposing attorney requesting the complete therapy records of a client involved in a contentious custody dispute. The client has not signed a release of information. The therapist's FIRST obligation is to:

  1. Release only a treatment summary rather than the full record to minimize the scope of disclosure
  2. Notify the client of the subpoena and discuss their options before taking any further action
  3. Comply with the subpoena within the legally required timeframe to avoid contempt of court
  4. Contact the issuing attorney directly to negotiate which portions of the record are disclosed
Show answer & explanation

Correct answer: B - Notify the client of the subpoena and discuss their options before taking any further action

Question 9

An MFT begins couples therapy without establishing any policy on individual contact or confidential disclosures. Midway through treatment, the wife contacts the therapist privately and reveals she has been emotionally involved with a coworker for six months. She pleads: 'It's not physical, and I'm ending it - please don't tell him.' The therapist is in an ethically compromised position PRIMARILY because:

  1. Without a predetermined disclosure policy, continuing couples therapy while holding this secret is ethically untenable
  2. The AAMFT Code of Ethics requires therapists to proactively disclose any information shared in individual contact that materially affects the nature or direction of the therapeutic contract
  3. The therapist has inadvertently created a dual relationship with each partner by holding separate confidences
  4. Confidentiality in couples therapy belongs to the dyadic unit and cannot be waived by one partner alone
Show answer & explanation

Correct answer: A - Without a predetermined disclosure policy, continuing couples therapy while holding this secret is ethically untenable

Question 10

During an individual session, a client tells his therapist: 'I've made up my mind. I'm going to shoot my ex-girlfriend. I know where she lives, I have a gun at home, and I'm done waiting.' The client refuses voluntary hospitalization. The therapist's response should MOST directly be guided by:

  1. Maintaining confidentiality to preserve the therapeutic alliance and address the threat therapeutically
  2. Documenting the threat thoroughly and consulting a supervisor before taking any action
  3. Initiating involuntary psychiatric hospitalization as the primary protective measure, then following up with notification to the potential victim the following day
  4. Warning the identified potential victim and taking steps to protect her, including contacting law enforcement
Show answer & explanation

Correct answer: D - Warning the identified potential victim and taking steps to protect her, including contacting law enforcement

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