tests


I wanted to call this post “advice for taking and passing the LMFT exam” but it turns out, having passed last week, that I don’t have much advice to give. The problem is that the ways the exam is hard are not things you can prepare for. I’ll describe that situation, for what it’s worth, then describe the process of taking the test, and give the few pieces of advice I can offer. Take that advice with several grains of salt, though, because when you pass, they don’t tell you your score. I have no idea if I passed with flying colors or barely scraped by. For reasons I’m about to get into, I wouldn’t be surprised either way. I really can’t say if I over-prepared and rocked it or underprepared and got lucky.

The material you have to know is not that hard. With a few exceptions, it’s the same stuff you learned in your grad school program, the same stuff you’ve been drilling in your internship. The test is hard mostly because the writing is terrible. Have you ever read something that has been passed through several languages in a translator program, then back into English? That is how the questions, and especially the answers, read. Most of them. They often barely make sense and some of it is complete nonsense. I doubt they used the translator trick, so it may be that they looked up the most obscure synonym for each word and then garbled up the grammar a bit to top it off. I would be ashamed to be associated with the writing of that exam. I do not consider it an ethical way to make an exam difficult. Unfortunately, that is the situation.

The second reason it is hard is that you have to read and comprehend all of that garble at lightning speed. I read at a slightly above average speed with high comprehension and I had twelve minutes left at the end to review my marked questions. Twelve minutes left at the end of a four hour test.

So that’s my first piece of advice: If you’re a slower than average reader, see what you can do for special accommodations on time, and definitely if English is your second language. I don’t know what’s available in that way, but look into it and take what you can get.

The third reason is that it’s just difficult to sit and concentrate that hard for four hours without stopping. Your body will hurt, if it has that tendency. If you have body or pain issues I would look into what accommodations they have to offer.

—-

The process of taking the test: I took mine in Riverside, so this may vary, and because you have to take the ethics exam right away now, you probably know all of this stuff already. You can skip this and the next paragraphs. PSI, the testing company has a suite in an office building. You walk into their lobby and the staff signs you in, takes your photo, and you wait a bit. The staff is very nice and professional. There is a rack to hang your coat and you can get a locker. (The PSI materials say that you don’t get a locker, but you can.) They let me take my migraine meds in on a tissue, but you can’t take anything else. I wished I’d worn a long sleeve shirt because it was a bit cool for me and I couldn’t take my sweatshirt in. They provide a pencil and scratch paper. You sit in one of fifteen or twenty cubicles with a PC computer, mouse, and keyboard. It’s pretty quiet. They offer you earplugs but I didn’t need them, and I’m pretty sensitive to noise. You run through some instructions and practice questions to get the hang of it. It’s pretty easy. Then you start the test and have four hours to finish 170 questions. That’s less than 90 seconds per question. There are three or four counters at the top of your screen, counting questions, up and down, and time. I can’t remember if the timer counted up or down or both, but I remember it being pretty easy to use. I would occasionally multiply my number of questions answered by 1.5 to make sure I was on track to get through every question. For example, after answering question 40, I could check that I was well under one hour into the exam. You can take breaks whenever you want, but the clock won’t stop. I took two breaks. The first was about a minute, to eat a few bites of a date bar I left in my coat pocket, about an hour and a half into the exam. The second was to pee, at about three hours in. That took five or six minutes, because the bathroom is down the hall and the staff has to escort you. I’m glad I took the breaks. I imagine that seven or eight extra minutes at the end of the exam would not have been very useful after hours of low blood sugar and holding pee.

If you have any time left, you can go back and look at questions you marked. I had time to look at a few and changed one answer. Then you finish. They make you click “yes” on a few versions of “Yes, I understand this will end my test and I can’t go back” before ending, so you can’t end the test accidentally. You walk back out into the lobby, grab your stuff, and get your results. I think if you fail they tell you your score, but I’m not sure. There is also the possibility that the BBS is re-analyzing how the exam is performing and you won’t find out if you passed for another month or so. That happened to me for my ethics exam, and it’s much nicer to know immediately how you did. I was in a bit of a daze after the exam and walked around the roads near the test center for a while before I felt like driving.

——

To prepare for the exam, I bought the Therapist Development Center’s MFT Clinical Exam package and did their 65 hour (versus 110 hour) track. I can’t say how it compares to Grossman or AATBS because I’ve never seen those packages. I can say that I used a Grossman practice-test package to study for the ethics exam and passed, but I’m pretty sure that I spent too much time studying that way. I basically tried to reverse-engineer the test using the practice tests plus the legal statutes and CAMFT Code of Ethics, which took a long time—a little over 70 hours of dedicated studying. The TDC package helped me avoid rabbit holes and working too long. TDC’s 65-hour track took me 68 hours to complete, plus I did an extra eight hours of study on the DSM-5, having been trained exclusively on the DSM-IV-TR. I made two outlines of the DSM-5, one of timeline information, like how long you need symptoms for each diagnosis, and one for age limit information. (I put those up here and here.) I also spent about four hours reading (and rereading) the CAMFT Code of Ethics, California statutes, and legal/ethics articles from CAMFT’s Therapist magazine archives.

Again, I have no idea how I would have done without studying that way, but I went in feeling as well-prepared as I could have. I barely studied the last couple days before the test because I felt like I knew the material. I remember thinking, “If I don’t pass, I’m not sure what I will do for the next four months, because I already know this stuff.”

So I can recommend the Therapist Development Center material. The extra DSM study didn’t help me that I remember on the exam—the TDC coverage would have been enough. I could probably say the same for the Code of Ethics and statutes reading. I don’t recall the test getting very nit-picky about any of that stuff. That’s not how they made the exam difficult, though I would have preferred it that way. Even if it was extra studying, I feel good about having done it. We MFTs should know that stuff cold.

That was likely the last multi-hour multiple choice exam I’ll ever have to take. I’m fine with that. Now it’s time to focus on setting up my private practice!

Schizophrenia is a fascinating set of phenomena, the study of which has launched a thousand ships including, arguably, my field, family therapy; many of the original family therapists left psychiatry to study schizophrenia (or, as the DSM would have me write it, Schizophrenia–capitalizing words gives them more authority, don’t you think?) as an interactive process. That is, if all behaviors make sense in their context, what context might make schizophrenic behavior necessary?

There was an almost violent backlash against this line of thinking, as it seemed to (and did, in many cases) blame mothers for their schizophrenic children–as in the unfortunate phrase “schizophrenogenic mother.” The conventional wisdom about schizophrenia these days reads like a pharmaceutical company press release, something like, “Schizophrenia is a biological disease of the brain which is at present incurable, but there are drugs which can help manage the symptoms, and if taken regularly can provide a decent quality of life.”

So schizophrenia is assumed to be a biological disease of the brain though it, like every other Mental Disorder, has no laboratory test that can detect its presence. The best we can do is a set of behavioral diagnostic criteria which, frankly, are a bit of a mess. You may notice as you read that different flavors of schizophrenia may have nothing or little in common with each other. Are they really the same “disease”? We don’t know.

We do have good evidence that you can inherit, in some fashion, a tendency for one of these constellations of behaviors. There is good evidence that environmental factors are also important, though they are not a big part of the mainstream discussion. We also have evidence that therapy helps in a lot of cases. There is some (hotly contested, I’m sure) evidence from the World Health Organization that unmedicated schizophrenics can eventually recover while those on medication do not. Here is a trailer for a moving documentary about two recovered women and the public perception of schizophrenia, called Take These Broken Wings. Also, consider checking out the documentary A Brilliant Madness, about John Nash, in which puts the lie to A Brilliant Mind, which showed Nash recovering with the help of psychopharmaceuticals.

The DSM says that schizophrenia may be overdiagnosed (or at least is diagnosed more often) in African- and Asian-American men, that it affects men differently than women (men tend towards the negative symptoms were women tend towards delusions and hallucinations), and that incidence rates are something like .5-1.5% of adults.

Here are a few terms that you’ll need to know to get through the criteria:

affective flattening: does not show emotion. Also, “affect” means “emotion” to scientists and people who like to talk like scientists.

alogia: lack of speech.

avolition: lack of motivation.

prodromal: symptoms coming early on in the course of a disease.

echolalia: repetition of others’ speech sounds.

echopraxia: repetition of others’ movements

And here are the diagnostic criteria, word-for-word, from the DSM-IV-TR, pp. 312-319:

Diagnostic criteria for Schizophrenia

A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

(1) delusions

(2) hallucinations

(3) disorganized speech (e.g. frequent derailment or incoherence)

(4) grossly disorganized or catatonic behavior

(5) negative symptoms, i.e., affective flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.

B. Social/occupational dysfunction: For a significatn portion of the time since th onset of the distrubance, one or more major areas of functioning such as work, interpersonal relations, or self-care are mardekly below the level achieved prior to the onset (or when the onset is in childhood or adolewscence, faliure to achieve expected level of interpersonal, academic, or occupational achievement).

C. Duration: Continuou signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. Doring these prodromal or residual periods, the signs of the ditrubance may be manifested by only negative symptoms or two or more symptoms listen in Criterion A pressent in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition.

F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

Classification of longitudinal course (can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms):

Episodic With Interepisode Residual Symptoms (episodes are difined by the reemergence of prominent psychotic symptoms); also specify if: With Prominent Negative Symptoms

Episodic With No Interepisode Residual Symptoms

Continuous (prominent psychotic symptoms are present throughout the period of observation); also specify if: With Prominent Negative Symptoms

Single Episode In Partial Remission; also specify if: With Prominent Negative Symptoms

Single Episode In Full Remission

Other or Unspecified Pattern

Diagnostic criteria for 295.30 Paranoid Type

A type of Schizophrenia in which the following criteria are met:

A. Preoccupation with one or more delusions or frequent auditory hallucinations.

B. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.

Diagnostic criteria for 295.10 Disorganized Type

A type of Schizophrenia in which the following criteria are met:

A. All of the following are prominent:

(1) disorganized speech

(2) disorganized behavior

(3) flat or inappropriate affect

B. The criteria are not met for Catatonic Type.

Diagnostic criteria for 295.20 Catatonic Type

A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:

(1) motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor

(2) excessive motor activity (that is apparently purposeless and not influenced by external stimuli

(3) extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism

(4) peculiarities of voluntary movement as evidenced by posturing (voluntary assumptions of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing

(5) echolalia or echopraxia

Diagnostic criteria for 295.90 Undifferentiated Type

A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.

Diagnostic criteria for 295.60 Residual Type

A type of Schizophrenia in which the following criteria are met:

A. Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.

B. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

April 9, 2010

Dear Nathen,

We are very pleased to inform you that you passed the comprehensive exam. Our standard in grading this exam is high; your work was of a very high quality. Congratulations!

You have worked very hard and you have demonstrated excellent understanding of core course material. We look forward to working with you as you move into your clinical work. In the Beginning Practicum course Dr. Tiffany Brown will continue to inform you about the Advanced Practicum course, about internship options throughout the community, and about orientation dates and plans for beginning at the Center for Family Therapy.

The vast majority of your cohort received a passing score this year. This is a statement of both your individual abilities and the support you give each other.

Again, congratulations.

Deanna Linville, Ph.D., LMFT

CFT Program & Clinical Director

Assistant Professor

Couples and Family Therapy Program

University of Oregon

OK, I’m done with my comps exam. It went well, I think. I’ll find out in a couple weeks. I’m already a week into my new term and am starting my reading. Here’s my reading list for the next 9 weeks. Each one of these is a chapter or an article for either Child & Family Assessment, Group Therapy, Wellness & Spirituality Throughout the Life Cycle, or Beginning Practicum.

624 Yalom 1 3/31/2010
623 Strauss, Hungry for Connection BB
4/5/2010
623 Stith et al., the voices of children BB
4/5/2010
623 Gil 2000, Engaging families in therapeutic play BB
4/5/2010
609 Brock ch 1 4/5/2010
609 Brock ch 2 4/5/2010
609 BB ch1 in Essential skills in family therapy 4/5/2010
624 Yalom 2 4/7/2010
624 Yalom 3 4/7/2010
624 Yalom 4 4/7/2010
630 Walsh 1 4/9/2010
630 Walsh 2 4/9/2010
630 Walsh 3 4/9/2010
630 Odell BB 4/9/2010
630 Prest & Keller 4/9/2010
623 Moon 1998 Family therapy w intellectually gifted BB
4/12/2010
623 Prober 2004 understanding the rainforest mind BB
4/12/2010
623 Mahoney, Exceptional children BB
4/12/2010
623 Gil 2005 From senstivity to competence BB
4/12/2010
623 Meth 2000 Involving fathers BB
4/12/2010
623 Canino 2000 Diagnostic categories BB
4/12/2010
609 Brock ch 3 4/12/2010
609 Prochaska 1999 How do people change BB 4/12/2010
609 essential skills ch 4 BB 4/12/2010
609 Experiential Text–1/6 of it 4/12/2010
Photo & bio stuff for camp as in email from maya of 3/29 4/14/2010
624 yalom 5 4/14/2010
624 Yalom 6 4/14/2010
624 Jacobs 6 4/14/2010
624 Jacobs 7 4/14/2010
630 Walsh 11 4/16/2010
630 Walsh 12 4/16/2010
630 Walsh 13 4/16/2010
630 Walsh 14 4/16/2010
630 Walsh 15 4/16/2010
630 Walsh 16 4/16/2010
630 Hodge BB 4/16/2010
623 http://www.circleofsecurity.org/docs/COS%20Teminology.pdf (terminology?) 4/19/2010
623 Booth 2005 Children’s attachment BB
4/19/2010
623 Rober 1998 Reflections on ways to create safe BB
4/19/2010
623 Watchel 2001 The language of becoming BB
4/19/2010
623 small group role play #1 4/19/2010
APPLY TO INTERNSHIPS 4/19/2010
609 Brock ch 4 4/19/2010
609 Snyder 1999 Hope as a psychotherapeutic BB 4/19/2010
609 BB essential skills ch 6 4/19/2010
609 Ward 2009 moving up the continuum BB 4/19/2010
609 Experiential Text–2/6 done 4/19/2010
624 Yalom 7 4/21/2010
624 Yalom 8 4/21/2010
624 Jacobs 8 4/21/2010
624 Jacobs 9 4/21/2010
630 Walsh 5 4/23/2010
630 Walsh 6 4/23/2010
630 Walsh 7 4/23/2010
630 Walsh 8 4/23/2010
630 Walsh 9 4/23/2010
623 small group role play #2 4/26/2010
623 assessment paper #1 due 4/26/2010
623 Nida 2000 Children’s social emotional development BB
4/26/2010
623 Canino 2000 influence of culture and multiple social BB
4/26/2010
609 Brock ch 5 4/26/2010
609 Gehart 2003 Theory based treatment planning ch1 BB 4/26/2010
609 Experiential Text–3/6 done 4/26/2010
624 Yalom 9 4/28/2010
624 Yalom 10 4/28/2010
624 Jacobs 2 4/28/2010
624 Jacobs 3 4/28/2010
624 Jacobs 4 4/28/2010
630 response paper #1 due 4/30/2010
630 Walsh 4 4/30/2010
630 SArmiento & Cardamil BB 4/30/2010
630 Walsh BB in Family Resiliency 4/30/2010
623 small group role play #3 5/3/2010
623 assessment paper #2 due 5/3/2010
623 Diller 2005 Bitter pill: Ritalin BB
5/3/2010
623 Josephson, Family therapy in an age of bio psych BB
5/3/2010
609 Brock ch 10 5/3/2010
609 Brock ch 11 5/3/2010
609 Brock ch 12 5/3/2010
609 Experiential Text–4/6 done 5/3/2010
609 http://www.dhs.state.or.us/abuse/ 5/3/2010
624 jacobs 5 5/5/2010
624 jacobs 12 5/5/2010
624 Yalom 11 5/5/2010
624 Yalom 12 5/5/2010
624 Wichman 2005 BB 5/5/2010
624 Midterm reflection paper–see syllabus 5/5/2010
630 McGoldrick Family Life Cycle BB ch 1 5/7/2010
630 McGoldrick Family Life Cycle BB ch 2 5/7/2010
630 McGoldrick Family Life Cycle BB ch 4 5/7/2010
630 Erickson BB 5/7/2010
630 Sheridan, Peterson, Rosen BB 5/7/2010
630 Pardeck & Pardeck BB** 5/7/2010
623 small group role play #4 5/10/2010
623 assessment paper #3 due 5/10/2010
623 Ketering 2007 child physical abuse and neglect BB
5/10/2010
623 Benoit 1999 Parental abuse and foster homes BB
5/10/2010
623 Caffaro 2008 sibling violence BB
5/10/2010
623 Sholevar, The family and the legal system BB
5/10/2010
623 Tonning 1999 Persistent & chronic neglect BB
5/10/2010
623 http://www.cdc.gov/nccdphp/ACE/ familiarize w purpose and outcomes 5/10/2010
609 Treatment Planning due 5/10/2010
609 Brock ch 7 5/10/2010
609 Brock ch 8 5/10/2010
609 Experiential Text–5/7 done 5/10/2010
624 Yalom 13 5/12/2010
624 Jacobs 10 5/12/2010
624 Jacobs 11 5/12/2010
624 Jacobs 16 5/12/2010
630 Neda article BB 5/14/2010
630 Danielsdotir, Burgar, Oliver-Pyatt BB 5/14/2010
623 assessment paper #4 due 5/17/2010
623 Wind 1999 Developmental identity crisis in nontrad BB
5/17/2010
623 Volkow 2004 the adolescent brain BB
5/17/2010
623 Cohen 2005 psychotherapy w same-sex attracted youth BB
5/17/2010
609 Brock ch 9 5/17/2010
609 Brock ch 10 5/17/2010
609 Bischoff 2002 The pathway toward clinical self-confidence BB 5/17/2010
609 Avis 2005 Narratives from the field BB 5/17/2010
609 Experiential Text–6/7 done 5/17/2010
624 Jacobs 13 5/19/2010
624 Jacobs 17 5/19/2010
624 Anderson 2009 BB 5/19/2010
630 Response paper #2 due 5/21/2010
630 DAvis, WArd, Storm BB 5/21/2010
623 Imberti 2008 the immigrants odyssey BB
5/24/2010
623 Fon 1999 Multiple traumas BB
5/24/2010
623 Dolbin-MacNab 2008 Grandparent raising grandchildren BB
5/24/2010
609 virtual dialogs due 5/24/2010
609 observation due 5/24/2010
609 Brock ch 6 5/24/2010
609 Experiential Text–done 5/24/2010
630 Papernow BB 5/28/2010
630 King & Wynne BB 5/28/2010
630 Clunis & Green BB** 5/28/2010
630 Corbet-Owen & KrugerBB** 5/28/2010
630 Interventions paper DUE 5/28/2010
630 Interventions handout DUE 5/28/2010
624 Final group reflection–overall–see syllabus 6/2/2010
630 Intervention presentations 6/4/2010
609 final exam 6/7/2010
624 Proposal for group term paper–8-10 pp ########

At 8 o’clock tomorrow morning, I am taking my first round of comprehensive exams for my couples and family therapy program. The purpose is to make sure we understand all of the theory we’ve been learning before we start seeing clients. If I don’t pass, I will be given another chance at it in the summer–I won’t be able to see clients this summer, but I could start in the fall.  I feel good about it. I am ready.

We will be graded Pass, Fail, or Pass With Distinction. I expect to get a Pass. I know the material quite well, but we’re supposed to write 3-4 single spaced pages on each of three questions, all in five hours. With citations. That’s a lot of typing. I’ve done three dry runs through the test, and the most I’ve been able to type, even with my outlines in front of me, is 7 1/2 pages, total. I’m not a fast typist, and I still have to think some about what I’m going to write. I’m fine with a “Pass.” Part of my learning curve is learning how to stop at “good enough.”

We’re allowed to bring food, drinks, ipods, and our reference lists with the references in any order. (I’ll paste in my list below). I’m also bringing my own keyboard (Microsoft Natural Keyboard Elite) and mouse (Logitech TrackMan Wheel). Five hours of fast typing–I need to be comfortable! I’d like to bring my chair, too (Herman Miller Aeron), but it’s difficult to bike with.

Tonight I’m treating myself to some food someone else made and getting into bed early.

Here are the questions. I’ve had them since December. Below them is my reference list. Wish me luck!

Question 1

Describe in detail systems theory, contrasting it with modernism (aka positivism). Be sure to include central concepts of both epistemologies and explain them fully. Also detail the main concepts of communication theory, and the connections between communication theory and system theory. Describe a family problem in detail using a specific model of family therapy (Structural, Strategic, Solution Focused, Experiential, EFT, Bowen) to describe the relevant associated concepts to understand the situation. What are the model specific concepts you will use to understand the family? How will it direct your treatment? What interventions might you utilize to help this family? Why are these interventions systemic? How will you evaluate outcomes based on this model of therapy? How will the common factors research influence your view of intervention with this family?

Question 2

Research ethics includes principles of social justice and dictates competence at each of the following levels: a) conducting research, b) consuming research, and c) utilizing the research literature.

Describe the key social justice considerations when conducting research, when evaluating the merits of a research study, and when utilizing research data as a clinician. In your response include notions of consent, validity, and the characteristics of a well-constructed qualitative and quantitative research designs. Finally, specifically describe how you will incorporate your knowledge of research and its relationship to social justice while a clinician at the CFT.

Question 3

Please describe a process for how you will develop a systemic diagnosis and treatment plan for the client system depicted in the vignette below. Carefully describe how your diagnostic impression and treatment plan are informed by your knowledge of (1) diversity, (2) empirically validated treatments, (3) relational ethics, (4) the diagnostic and statistical manual and (5) CFT theoretical frameworks (systems and communications theories). Finally, based on the vignette below, talk about your treatment approach and how it is informed by the five areas mentioned above. Clearly articulate your systemic diagnosis and treatment plan for this client system.

Kelly (39) and Kris (26) presented for couples therapy. The couple reports they have been together for about two years and are very serious about their future together. Kris reports they have “problems understanding each other. We just can’t communicate.” Kelly agrees and reports it’s been that way for several months. Every time they try to talk with each other about their problems they don’t get along and often engage in escalating verbal arguments. The arguments often lead to Kelly leaving the house very upset and not coming home until the next day. Each partner is hoping for it to get better and want to engage in ongoing couples therapy. Kris reports feeling down and “out of sorts” most of the time and has had difficulty in getting out of bed and making it to work on time the past few months; however, is able to have some good days feeling happy and energetic. After the third session, Kelly discloses to you over the phone that he is thinking of engaging in a sexual relationship with another partner but doesn’t want to bring it up in therapy yet, and doesn’t want you to, either. He states that he feels having another partner will help the relationship because he will “be able to get my needs met.” He further reports to you that they both occasionally seek out partners outside the relationship and feel an open relationship works for them, though made the decision years ago to just not talk about it when it is happening.

Comps References

Becvar, D. S. & Becvar, R. J. (2006). Family therapy: Systemic integration. Boston, MA: Pearson.

Burbatti, G. L. & Formenti, L. (1988). The Milan approach to family therapy. Northvale, NJ: Jason Aronson.

Fisch, R., Weakland, J. H., & Segal, L. (1982). The tactics of change: Doing therapy briefly. San Francisco, CA: Jossey-Bass.

Gehart, D. (2010). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation. Belmont, CA: Brooks/Cole.

Haley, J. (1993). Jay Haley on Milton H. Erickson. New York, NY: Brunner Mazel.

Madanes, C. (1991). Strategic family therapy. In A. S. Gurman & D. P. Kniskern (Eds.) Handbook of family therapy (pp. 396-416). Madison, WI: Routledge.

Nichols, M. P. & Schwartz, R. C. (2008). Family therapy: Concepts and methods. Boston, MA: Pearson.

Sandberg, J. G., Johnson, L. N., Dermer, S. B., Gfeller-Strouts, L. L., Seibold, J. M., Stringer-Seibold, T. A., Hutchings, Andrews, J. B., & Miller, R. B (1997). Demonstrated efficacy of models of marriage and family therapy: An update of Gurman, Kniskern, and Pinsof’s chart. The American Journal of Family Therapy, 25(2). 121-137.

Sprenkle, D. H. & Blow, A. J. (2004). Common factors and our sacred models. Journal of Marital and Family Therapy, 30(2), 113-126.

Watzlavick, P., Bavelas, J. B., & Jackson, D. D. (1967). Pragmatics of human communication: A study of interactional patterns, pathologies, and paradoxes. New York, NY: Norton.

Sells, S. P., Smith, T. E., & Newfield, S. N. (1996). A clinical science for the humanities: Ethnographies in family therapy. In S. Moon & D. Sprenkle (Eds.), Research Methods in Family Therapy (pp. 25-63). New York: Guilford.

National Institutes of Health (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. URL http://ohsr.od.nih.gov/guidelines/belmont.html

National Institutes of Health (2010). The Nuremberg code: Directives for human experimentation. URL http://ohsr.od.nih.gov/guidelines/nuremberg.html

Sue, S. (1999). Science, ethnicity and bias: Where have we gone wrong? American Psychologist 54(12), 1070-1077.

Freire, P. (1970). Pedagogy of the oppressed. New York, NY: Continuum.

Aronson, E., Ellsworth, P. C., Carlsmith, J. M., & Gonzales, M. H. (1989). Methods of Research in Social Psychology. Columbus, OH: McGraw-Hill.

Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches. Los Angeles, CA: Sage.

Corey, G., Corey, M.S., & Callanan, P. (2011). Issues and ethics in the helping professions (8th Ed.) Belmont, CA: Brooks/Cole Cengage Learning.

Fisch, R., Weakland, H., & Segal, L. (1982). The tactics of change. San Fransisco: Jossey-Bass.

American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.-TR). Washington, DC: American Psychchological Association.

Bettinger, M. (2006). Polyamory and gay men: A family systems approach. In J. J. Bigner (Ed) An introduction to GLBT family studies (pp. 161-181). New York, NY: Haworth.

LaSala, M. C. (2001). Monogamous or not: Understanding and counseling gay male couples.

Families in Society, 82(6), 605-611.