3 Couples Therapy Scenarios for MFT Exam Practice

Preparing for the AMFTRB MFT exam means more than memorizing theories and interventions—it means applying what you know to realistic, clinical situations. One of the MOST valuable ways to get ready is by reviewing therapy scenarios that reflect the challenges you’ll face as a practicing Marriage and Family Therapist. Below, we explore several couples therapy scenarios to help sharpen your diagnostic skills, improve clinical judgment, and build confidence for exam day.

Why Couples Therapy Scenarios Matter on the MFT Exam

The MFT exam is designed to test your ability to think like a therapist. That includes identifying presenting problems, selecting interventions, understanding client dynamics, and applying legal and ethical considerations. Case-based questions simulate what it’s like to be in the therapy room, and reviewing therapy scenarios prepares you to respond appropriately under pressure.

MFT Exam Scenario 1

Vera is working with a couple, Sally (33) and Stuart (34). They have been married for nearly a decade, but state they still fight about how to plan and go on vacations. Because travel is very important to them both, they feel this is an issue that needs to be resolved. They report that they also have some issues with general communication and money, but that they are happy and connected overall. Vera uses the Gottman Method in her work with couples.

Based on Sally and Stuart’s presenting issues, she would MOST likely proceed by:

A. Helping Stuart and Sally turn to one another when they feel frustrated
B. Validating Stuart and Sally and providing psychoeducation on managing gridlocked issues
C. Encouraging Stuart and Sally to recognize how they have found partners that resemble caregivers from the past
D. Assisting Stuart and Sally in defining clearer boundaries about their specific needs in the relationship

Correct answer: B. Validating Stuart and Sally and providing psychoeducation on managing gridlocked issues

Conflict resolution seems to be the main issue with this couple, so a Gottman Method therapist would focus on talking about gridlocked issues and helping couples “embrace” rather than feel defeated when recurrent issues emerge. They might then talk about turning to each other for increased attunement, but it appears that Stuart and Sally are already pretty happy and connected. Caregivers from the past is a concept in Imago therapy (not Gottman). This is not really a conversation about the need for boundaries, as we have no information about the boundaries within their marriage.

The National Licensing Exam for Marriage and Family Therapy, 2nd Edition. Pg 215.

MFT Exam Scenario 2

Sharon is a couples therapist working with a married couple, Tom (44) and Laura (43). They are seeking therapy to recover from Tom’s recent affair. During the informed consent process, Sharon reviews the risks and benefits of therapy, discusses treatment goals, and emphasizes the importance of both partners attending treatment. That evening, Tom leaves a voicemail on Sharon’s office phone line stating that he feels guilty because he’s still talking to the woman with whom he had an affair. He indicates that he will now stop all forms of communication because he sincerely wants to reconnect with his wife.

Given this information, what should Sharon do NEXT?

A. Inform Tom that either she or he needs to disclose this information in their next session
B. Inform Tom that couples therapy is not appropriate for them at this time and that she will be referring them both to individual therapists
C. Inform Tom that she would like him to share this information in their next session
D. Inform Tom about how she will proceed based on her practice’s secrets policy

Correct answer: D. Inform Tom about how she will proceed based on her practice’s secrets policy

This is a tricky situation, and it speaks to why having secret policies is so important when working with dyads or families. Without this policy in place, Sharon might be breaching Tom’s confidentiality should she disclose ongoing communication. Couples therapy may certainly still be appropriate. Sharon might tell Tom she wants him to talk about this with Laura during the next session, but her first step is reviewing her secrets policy.

Ethical, Legal, and Professional Issues in the Practice of Marriage and Family Therapy, 5th Edition. Pg 513.

MFT Exam Scenario 3

You are working with Frida and Jose, a new couple who want therapy to build emotional closeness and recover from Frida’s recent affair. You have had three sessions with this couple and believe you have established a good rapport. They don’t show up for their fourth session and don’t answer the phone when you call. The next day, Frida sends you an email saying, “Thank you so much. We got what we needed from you. We’re going to try to implement what you suggested and see how it goes. We’ll reach back out if we need anything else!”

As a couples therapist, you should NEXT:

A. Assume this means Frida doesn’t understand how therapy works and email her to remind her of the informed consent process
B. Assume this means Frida wants to terminate therapy, although you know they may want to return in the future
C. Assume this means Frida wants to terminate therapy, although you know this is a common type of resistance
D. Assume this means Frida is updating you on their progress but will likely be back for the next session

Correct answer: B. Assume this means Frida wants to terminate therapy, although you know they may want to return in the future

Many clients end therapy prematurely, and they have the autonomy to do so. It is important that you consider that this couple may return in the future. It would be insulting to assume Frida doesn’t know how therapy works, although you might follow up to clarify that she is terminating treatment with you at this time. It may be a form of resistance, but not all therapists perceive termination in such a way, and we don’t have enough information based on Frida’s email. It is unlikely Frida will just naturally return for the next session.

Ethical, Legal, and Professional Issues in the Practice of Marriage and Family Therapy, Updated (New 2013 Counseling Titles), 5th Edition. Pg 112.

Key Takeaways for the AMFTRB Exam

  • Understand various therapeutic models (Gottman Method, EFT, Structural Family Therapy, SFBT).
  • Analyze scenarios using systematic assessments before selecting interventions.
  • Practice empathy-driven, client-centered therapeutic techniques to address relational dynamics.

By regularly reviewing and analyzing these realistic scenarios, you’ll enhance your ability to navigate complex therapeutic situations effectively and confidently during the MFT exam.

Test Your MFT Skills With Pocket Prep

Mastering systemic case scenarios is key to becoming a confident and effective Marriage and Family Therapist. By practicing with realistic, exam-style cases, you’ll sharpen your clinical judgment and reinforce the theories and interventions essential to MFT practice.

Ready to test your knowledge of everything from treatment planning to family systems theory? Pocket Prep’s MFT Exam Prep covers the core domains of the exam and includes six quiz types—like Weakest Subject quizzes and timed Mock Exams—to help you focus your study and build confidence. Start strengthening your systemic thinking today!