NRNP 6645 PSYCHOTHERAPY WITH MULTIPLE MODALITIES
MIDTERM EXAM 2026/2027 | Questions and Verified Answers
| Grade A | Pass Guaranteed
Domain 1: Foundational Psychotherapy Concepts & Therapeutic Alliance (12
Questions)
Q1: A 28-year-old female patient with borderline personality disorder begins individual
therapy. During the fourth session, she becomes intensely angry when the therapist
suggests she arrived 15 minutes late, stating, "You're just like my mother—always
criticizing me!" She then threatens to quit therapy. Which therapeutic concept is the
PMHNP observing, and what is the most appropriate initial response?
A. Projection; immediately interpret the patient's anger as a defense against intimacy
B. Transference; explore the patient's feelings about the therapist while maintaining
boundaries [CORRECT]
C. Countertransference; disclose the therapist's own feelings about the comparison
D. Resistance; confront the patient about her avoidance of responsibility
Correct Answer: B
Rationale: The patient is demonstrating transference—the unconscious redirection of
feelings from significant figures (mother) onto the therapist. This is expected in
psychodynamic work, particularly with borderline personality disorder where early
attachment wounds are prominent. The appropriate response is to explore these
feelings within the therapeutic alliance while maintaining professional boundaries.
Option A mislabels the phenomenon (projection involves attributing one's own
,unacceptable thoughts to others; this is classic transference). Option C incorrectly
identifies countertransference (the therapist's reaction to the patient, not the patient's
reaction to the therapist). Option D misinterprets the clinical moment as resistance
rather than valuable therapeutic material. Exploring transference deepens therapeutic
work and provides corrective emotional experiences.
Q2: A PMHNP has been working with a 45-year-old male patient for six months. The
patient consistently praises the therapist's competence and brings small gifts to
sessions. The therapist notices feeling unusually protective and pleased by the patient's
admiration, sometimes extending sessions beyond the scheduled time. Which
phenomenon requires immediate clinical attention?
A. Therapeutic alliance strengthening
B. Countertransference enactment threatening boundaries [CORRECT]
C. Positive transference that should be left unaddressed
D. Appropriate therapeutic flexibility
Correct Answer: B
Rationale: The therapist is experiencing countertransference—emotional reactions to
the patient that require self-awareness and management. Extending sessions and
feeling unusually protective indicates enactment (behavioral expression of
countertransference) that threatens professional boundaries. This requires immediate
supervision, consultation, or personal therapy to prevent harm. Option A misinterprets
boundary violations as alliance. Option C is dangerous; positive transference should be
monitored, and boundary violations addressed regardless of transference type. Option D
,confuses flexibility with boundary dissolution. The therapist must restore boundaries
and explore the countertransference to understand what the patient is evoking.
Q3: A patient with major depressive disorder states, "I know I'm not really sick—other
people have it much worse. I'm just being lazy and weak." This statement represents
which cognitive distortion?
A. Catastrophizing
B. Minimization and labeling [CORRECT]
C. Mind reading
D. Emotional reasoning
Correct Answer: B
Rationale: The patient is minimizing her suffering ("not really sick") and labeling herself
with pejorative terms ("lazy," "weak"). This reflects internalized stigma and harsh
self-criticism common in depression. Option A (catastrophizing) involves predicting
worst-case scenarios. Option C (mind reading) assumes knowledge of others' thoughts.
Option D (emotional reasoning) uses feelings as evidence of truth ("I feel worthless,
therefore I am"). Identifying cognitive distortions allows targeted cognitive restructuring
interventions in CBT.
Q4: During the initial session with a trauma survivor, which action best establishes a
therapeutic alliance while maintaining trauma-informed principles?
A. Immediately obtain detailed trauma history to understand the full clinical picture
, B. Establish safety, collaborative goals, and patient autonomy regarding disclosure
[CORRECT]
C. Focus primarily on symptom reduction techniques
D. Explain that the therapist will direct all treatment decisions for the patient's benefit
Correct Answer: B
Rationale: Trauma-informed care prioritizes safety, trustworthiness, peer support,
collaboration, empowerment, and cultural humility. Establishing safety and patient
autonomy prevents retraumatization. Option A risks overwhelming the patient and
violating trauma principles (safety first, pacing disclosure). Option C is premature
without establishing safety and alliance. Option D contradicts empowerment principles.
The therapeutic alliance in trauma work requires particular attention to power dynamics
and patient control.
Q5: A patient with obsessive-compulsive disorder describes spending three hours daily
checking locks. The therapist notices feeling frustrated and impatient, thinking, "This is
irrational—just stop checking." Which response demonstrates appropriate therapeutic
stance?
A. "You're wasting your life on these rituals. We need to stop this behavior now"
B. "I notice I'm feeling frustrated, which tells me how distressing this must be for you.
Let's understand what function the checking serves" [CORRECT]
C. "Have you tried just not checking? It seems simple enough"
D. "Your family must be very frustrated with you"
Correct Answer: B
MIDTERM EXAM 2026/2027 | Questions and Verified Answers
| Grade A | Pass Guaranteed
Domain 1: Foundational Psychotherapy Concepts & Therapeutic Alliance (12
Questions)
Q1: A 28-year-old female patient with borderline personality disorder begins individual
therapy. During the fourth session, she becomes intensely angry when the therapist
suggests she arrived 15 minutes late, stating, "You're just like my mother—always
criticizing me!" She then threatens to quit therapy. Which therapeutic concept is the
PMHNP observing, and what is the most appropriate initial response?
A. Projection; immediately interpret the patient's anger as a defense against intimacy
B. Transference; explore the patient's feelings about the therapist while maintaining
boundaries [CORRECT]
C. Countertransference; disclose the therapist's own feelings about the comparison
D. Resistance; confront the patient about her avoidance of responsibility
Correct Answer: B
Rationale: The patient is demonstrating transference—the unconscious redirection of
feelings from significant figures (mother) onto the therapist. This is expected in
psychodynamic work, particularly with borderline personality disorder where early
attachment wounds are prominent. The appropriate response is to explore these
feelings within the therapeutic alliance while maintaining professional boundaries.
Option A mislabels the phenomenon (projection involves attributing one's own
,unacceptable thoughts to others; this is classic transference). Option C incorrectly
identifies countertransference (the therapist's reaction to the patient, not the patient's
reaction to the therapist). Option D misinterprets the clinical moment as resistance
rather than valuable therapeutic material. Exploring transference deepens therapeutic
work and provides corrective emotional experiences.
Q2: A PMHNP has been working with a 45-year-old male patient for six months. The
patient consistently praises the therapist's competence and brings small gifts to
sessions. The therapist notices feeling unusually protective and pleased by the patient's
admiration, sometimes extending sessions beyond the scheduled time. Which
phenomenon requires immediate clinical attention?
A. Therapeutic alliance strengthening
B. Countertransference enactment threatening boundaries [CORRECT]
C. Positive transference that should be left unaddressed
D. Appropriate therapeutic flexibility
Correct Answer: B
Rationale: The therapist is experiencing countertransference—emotional reactions to
the patient that require self-awareness and management. Extending sessions and
feeling unusually protective indicates enactment (behavioral expression of
countertransference) that threatens professional boundaries. This requires immediate
supervision, consultation, or personal therapy to prevent harm. Option A misinterprets
boundary violations as alliance. Option C is dangerous; positive transference should be
monitored, and boundary violations addressed regardless of transference type. Option D
,confuses flexibility with boundary dissolution. The therapist must restore boundaries
and explore the countertransference to understand what the patient is evoking.
Q3: A patient with major depressive disorder states, "I know I'm not really sick—other
people have it much worse. I'm just being lazy and weak." This statement represents
which cognitive distortion?
A. Catastrophizing
B. Minimization and labeling [CORRECT]
C. Mind reading
D. Emotional reasoning
Correct Answer: B
Rationale: The patient is minimizing her suffering ("not really sick") and labeling herself
with pejorative terms ("lazy," "weak"). This reflects internalized stigma and harsh
self-criticism common in depression. Option A (catastrophizing) involves predicting
worst-case scenarios. Option C (mind reading) assumes knowledge of others' thoughts.
Option D (emotional reasoning) uses feelings as evidence of truth ("I feel worthless,
therefore I am"). Identifying cognitive distortions allows targeted cognitive restructuring
interventions in CBT.
Q4: During the initial session with a trauma survivor, which action best establishes a
therapeutic alliance while maintaining trauma-informed principles?
A. Immediately obtain detailed trauma history to understand the full clinical picture
, B. Establish safety, collaborative goals, and patient autonomy regarding disclosure
[CORRECT]
C. Focus primarily on symptom reduction techniques
D. Explain that the therapist will direct all treatment decisions for the patient's benefit
Correct Answer: B
Rationale: Trauma-informed care prioritizes safety, trustworthiness, peer support,
collaboration, empowerment, and cultural humility. Establishing safety and patient
autonomy prevents retraumatization. Option A risks overwhelming the patient and
violating trauma principles (safety first, pacing disclosure). Option C is premature
without establishing safety and alliance. Option D contradicts empowerment principles.
The therapeutic alliance in trauma work requires particular attention to power dynamics
and patient control.
Q5: A patient with obsessive-compulsive disorder describes spending three hours daily
checking locks. The therapist notices feeling frustrated and impatient, thinking, "This is
irrational—just stop checking." Which response demonstrates appropriate therapeutic
stance?
A. "You're wasting your life on these rituals. We need to stop this behavior now"
B. "I notice I'm feeling frustrated, which tells me how distressing this must be for you.
Let's understand what function the checking serves" [CORRECT]
C. "Have you tried just not checking? It seems simple enough"
D. "Your family must be very frustrated with you"
Correct Answer: B
