NCMHCE NCMHCE - National Clinical Mental Health Counseling Examination Family Systems and Couples Counseling 5 â Questions and Answers
Question 1: A couples counselor is working with partners who fight constantly about household chores. One partner states, 'You never appreciate anything I do.' According to the Gottman method, this is an example of:
- Contempt
- Criticism (Correct answer)
- Stonewalling
- Defensiveness
Correct answer: Criticism
Criticism attacks the partner's character rather than addressing a specific behavior, often using 'always' or 'never' language, and is one of Gottman's Four Horsemen predictors of relationship dissolution.
Question 2: In contextual family therapy (Boszormenyi-Nagy), 'relational ethics' refers to:
- The therapist's duty to maintain confidentiality with all family members equally
- The balance of fairness, obligations, and entitlements among family members across generations (Correct answer)
- The ethical code governing co-therapy relationships
- Rules about appropriate emotional boundaries in the therapeutic alliance
Correct answer: The balance of fairness, obligations, and entitlements among family members across generations
Boszormenyi-Nagy's contextual therapy centers on relational ethicsâthe multigenerational ledger of fairness, entitlements earned, and obligations owed between family members.
Question 3: A therapist working with a blended family notices that the stepparent attempts to discipline the biological children while the biological parent undercuts those efforts. The MOST systemic intervention is to:
- See the stepparent and biological parent separately to validate each perspective
- Help the couple establish a unified parental alliance and clarify roles before enforcement (Correct answer)
- Refer the children to individual therapy for adjustment issues
- Educate the biological parent about the importance of consistent parenting
Correct answer: Help the couple establish a unified parental alliance and clarify roles before enforcement
Structural family therapy prioritizes strengthening the parental/executive subsystem boundary so that the couple functions as a unified hierarchical unit before addressing child behavior.
Question 4: During a couples session, one partner suddenly becomes silent, avoids eye contact, and gives monosyllabic answers. Gottman's research identifies this pattern as stonewalling, which physiologically is associated with:
- Parasympathetic dominance causing hypo-arousal
- Floodingâdiffuse physiological arousal above 100 BPM (Correct answer)
- Vagal suppression causing emotional numbing
- A dominant cortisol spike causing freeze response
Correct answer: Floodingâdiffuse physiological arousal above 100 BPM
Gottman's research shows stonewalling is typically a response to floodingâheart rate exceeding 100 BPMâwhere the partner shuts down to manage overwhelming physiological arousal.
Question 5: A family therapist using the Milan systemic approach introduces a question such as: 'If your mother were here, how do you think she would describe the relationship between your father and your sister?' This technique is called:
- Circular questioning (Correct answer)
- Hypothetical future questioning
- Reflexive questioning
- Externalizing questioning
Correct answer: Circular questioning
Circular questioning, developed by the Milan team, explores relationships and differences in perception by asking one member to describe or speculate about the relationship between two others.
Question 6: A counselor assesses a couple using the PREPARE/ENRICH inventory. The PRIMARY purpose of this assessment is to:
- Diagnose relational disorders according to DSM-5 criteria
- Identify relationship strengths and growth areas to guide psychoeducation and skill-building (Correct answer)
- Determine whether the couple is appropriate for conjoint versus individual therapy
- Measure attachment style to guide EFT treatment planning
Correct answer: Identify relationship strengths and growth areas to guide psychoeducation and skill-building
PREPARE/ENRICH is a normed couple assessment tool that identifies relationship strengths and growth areas across domains such as communication, conflict resolution, and family of origin, used to guide structured feedback and skills training.
Question 7: A Latino couple seeks therapy, and the husband states he makes all major family decisions as the head of the household. A culturally competent family therapist SHOULD:
- Challenge the patriarchal structure as inherently harmful to the wife's autonomy
- Explore whether this structure is ego-syntonic for both partners and consistent with their cultural values (Correct answer)
- Reframe the wife's deference as a trauma response requiring individual therapy
- Apply structural family therapy to immediately realign the power hierarchy
Correct answer: Explore whether this structure is ego-syntonic for both partners and consistent with their cultural values
Culturally competent practice requires exploring whether a family's hierarchical structure is a valued, mutually accepted cultural norm versus a source of distress before imposing an external framework.
NCMHCE NCMHCE - National Clinical Mental Health Counseling Examination Family Systems and Couples Counseling 5
A couples counselor is working with partners who fight constantly about household chores.
One partner states, 'You never appreciate anything I do.' According to the Gottman method, this is an example of: