Answer and Rationale for FREE Practice Question on Middle Phase of Treatment

By Robin Gluck on January 18, 2018

Yesterday we posted a question on approaching questions asking about the middle phase of treatment for the MFT exams. Today we have the answer and rationale for you. Did you get this question right?



A 46-year-old man who emigrated from Ecuador eight years earlier has been in therapy for several months to address symptoms of anxiety and difficulties with sleep. During the first month of treatment, the therapist developed a good rapport with the client and collaboratively identified goals for treatment. The client’s chief complaint is that he is up most evenings with his mind racing about finances, and his family that is still in Ecuador, including his inability to care for his aging parents who are so far away. The client shares that due to the lack of sleep he has been exhausted at work and is constantly scared he is going to lose his job. Which of the following actions would a Cognitive Behavioral Therapist utilize in the middle stage of treatment?

A. Practice diaphragmatic breathing in sessions with the client and discuss how he can integrate these skills into his daily routine to decrease anxiety levels.

B. Utilize an automatic thought record on a daily basis to better understand cognitive distortions and develop healthier alternative thoughts.

C. Ask the client to identify times when his anxiety did not interfere with his sleep and compliment his ability to use successful techniques.

D. Educate the client about the different cognitive distortions and collaboratively identify those he is employing that cause his anxiety and sleep disorder.

The best answer in this situation is answer B.

  • Answer (A) is something a CBT therapist would do and it is an appropriate intervention to use based on the presenting issue, but this would be more suitable to earlier stages of treatment. Remember, by the middle stage of treatment we’ve already laid the foundation for making change happen. This means we already would have identified ways for the client to integrate relaxation techniques into his daily routine.
  • Answer (D) is wrong for a similar reason. Again, this is an intervention that would likely be used by a CBT therapist and it makes sense based on the information shared in the vignette. However, by the time you are in the middle stage of treatment, the client should already have an understanding of cognitive distortions.
  • Answer (C) is wrong for a different reason. Similar to answers (A) and (D), this intervention would properly address the client’s anxiety, but it is more closely associated with Solution Focused therapy, not CBT.
  • Answer (B) is the best option available. The client would have learned how to use an automatic thought record at the onset of treatment, and would continue to utilize it through the middle stage of treatment. This intervention addresses the client’s chief complaint, it is strongly linked to CBT, and it would be used in the middle stage of treatment. There are three parts to the question being asked (actions, CBT, and middle stage) and this is the only answer option that correctly addresses all of them.

Which answer did you choose? Does the rationale fit with your understanding of the topic and how you would approach a middle phase intervention question? If you have any further questions feel free to check in with a TDC coach. We are here to support you all along the way. And if you came up with the same answer-great job! You are on the right track to getting licensed.

Still haven’t signed up for an exam preparation program? Or have you already passed the exam and need to complete your continuing education requirements? Our structured, straightforward approach will provide you with exactly what you need!

We look forward to helping you PASS your exam with confidence!




Commenter Name
December 25, 2018

These are the sort of questions that I really find very hard to answer. Thanks for this example!

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