WALDEN UNIVERSITY -- COLLEGE OF NURSING
NRNP 6645 Psychotherapy
Midterm Exam
Official Practice Exam . 2026/2027 Edition
100 Questions | 120 Minutes | 80% Passing Score | 6 Sections
TABLE OF CONTENTS
Section 1: Psychotherapy Theories and Models (17 Questions)
Section 2: Therapeutic Alliance and Relationship (12 Questions)
Section 3: Assessment and Treatment Planning in Psychotherapy (13 Questions)
Section 4: Evidence-Based Psychotherapy Interventions (14 Questions)
Section 5: Ethical, Legal, and Professional Issues (11 Questions)
Section 6: Special Populations, Outcomes, and Advanced Techniques (33 Questions)
EXAM INSTRUCTIONS
Read each question carefully. Select the single best answer from the four options provided. Each question includes a
rationale explaining the correct answer and why a key distractor is incorrect. A score of 80% or higher (80 of 100) is
required to pass. Manage your time to allow approximately 1.2 minutes per question. Review all answers before
submission.
NRNP 6645 Psychotherapy -- 2026/2027 | Passing Score: 80% | Page 0 of 0
NRNP 6645 Psychotherapy Midterm Exam | Walden University | 2026/2027 Edition
,Section 1: Psychotherapy Theories and Models
Q1. Question 1 of 100
Q1. A 35-year-old woman in psychotherapy describes a recurring dream about being trapped in a small room with
no doors. The therapist explores how this dream might represent unconscious conflicts from childhood. This
approach is most consistent with which theoretical model?
A. Psychodynamic psychotherapy which emphasizes unconscious processes, dream analysis, and
the influence of early childhood experiences on current functioning
B. Cognitive behavioral therapy which focuses on identifying and restructuring distorted thought patterns
that maintain psychological distress
C. Person-centered therapy which prioritizes the client's subjective experience and innate capacity for
self-actualization through unconditional positive regard
D. Existential therapy which addresses concerns about freedom, responsibility, and the search for meaning
in human existence
Correct Answer: A
Rationale:
The therapist's focus on unconscious processes, dream analysis, and childhood conflicts is the hallmark of
psychodynamic psychotherapy, rooted in Freudian and neo-Freudian theory. CBT (choice B) would focus on
conscious thoughts and behaviors, not dreams. Person-centered therapy (choice C) avoids interpretation and
follows the client's lead. Existential therapy (choice D) addresses meaning and freedom, not unconscious conflict.
Q2. Question 2 of 100
Q2. A 42-year-old man with depression tells his therapist that he must be perfect at work or he is a complete
failure. The therapist helps him examine the evidence for and against this belief and generates alternative
thoughts. This intervention is a core technique of which therapeutic approach?
A. Gestalt therapy using the empty chair technique to dialogue with critical internal voices
B. Cognitive behavioral therapy using cognitive restructuring to challenge all-or-nothing thinking
patterns
C. Psychodynamic therapy using free association to uncover the origin of perfectionistic defenses
D. Solution-focused brief therapy using the miracle question to envision life without perfectionism
Correct Answer: B
Rationale:
Examining evidence for and against beliefs and generating alternative thoughts is cognitive restructuring, a core
CBT technique targeting cognitive distortions like all-or-nothing thinking. The empty chair (choice A) is a Gestalt
experiential technique. Free association (choice C) is a psychodynamic method for accessing unconscious
material. The miracle question (choice D) is a solution-focused technique for building a vision of change.
NRNP 6645 Psychotherapy -- 2026/2027 | Passing Score: 80% | Page 1 of 0
,Q3. Question 3 of 100
Q3. A 28-year-old woman in therapy says she feels stuck and directionless in life. The therapist reflects her
feelings and says, 'It sounds like you are struggling to find what gives your life meaning and purpose.' The
therapist then explores the client's sense of freedom and responsibility in creating meaning. This approach is
most consistent with which theoretical orientation?
A. Behavioral therapy using contingency management to increase adaptive behaviors
B. Dialectical behavior therapy using distress tolerance skills to manage existential anxiety
C. Existential therapy addressing the client's struggle with meaning, freedom, and authentic
existence
D. Adlerian therapy exploring the client's inferiority complex and style of life
Correct Answer: C
Rationale:
The focus on meaning, purpose, freedom, and responsibility is characteristic of existential therapy, which helps
clients confront the givens of existence including meaninglessness and the freedom to create meaning.
Behavioral therapy (choice A) focuses on observable behavior change. DBT (choice B) targets emotion
dysregulation. Adlerian therapy (choice D) focuses on inferiority and social interest, not existential givens.
Q4. Question 4 of 100
Q4. A 50-year-old man in group therapy becomes tearful when discussing his divorce. The therapist invites him to
stay with his feelings and notice what he experiences in his body right now. The therapist asks him to speak
directly to the group about his experience. This intervention exemplifies which therapeutic approach?
A. Cognitive therapy identifying automatic thoughts associated with the emotional distress
B. Psychodynamic therapy interpreting transference patterns within the group setting
C. Rational emotive behavior therapy disputing irrational beliefs about divorce
D. Gestalt therapy emphasizing present-moment awareness, bodily experience, and here-and-now
contact with others
Correct Answer: D
Rationale:
The emphasis on present-moment awareness, bodily sensation, and direct contact with others in the
here-and-now is characteristic of Gestalt therapy, which prioritizes awareness and contact over interpretation or
cognitive analysis. Cognitive therapy (choice A) would focus on thoughts. Psychodynamic therapy (choice B)
would explore transference and unconscious material. REBT (choice C) would dispute irrational beliefs.
NRNP 6645 Psychotherapy -- 2026/2027 | Passing Score: 80% | Page 2 of 0
, Q5. Question 5 of 100
Q5. A therapist working with a 30-year-old woman with social anxiety uses exposure hierarchies, behavioral
experiments, and skills training while assigning between-session practice tasks. The therapist also collaboratively
develops a formulation linking thoughts, feelings, and behaviors. This integrated approach represents which
evidence-based model?
A. Cognitive behavioral therapy which integrates cognitive restructuring with behavioral activation
and exposure techniques
B. Psychodynamic psychotherapy which uses the therapeutic relationship to resolve intrapsychic conflicts
C. Acceptance and commitment therapy which uses mindfulness and values-based action to increase
psychological flexibility
D. Interpersonal psychotherapy which focuses on resolving interpersonal problems that maintain
depressive symptoms
Correct Answer: A
Rationale:
Exposure hierarchies, behavioral experiments, skills training, homework, and cognitive formulation are core
components of CBT. Psychodynamic therapy (choice B) does not use exposure hierarchies or homework. ACT
(choice C) uses mindfulness and values rather than exposure hierarchies and cognitive restructuring. IPT (choice
D) focuses on interpersonal problems, not cognitive-behavioral techniques.
Q6. Question 6 of 100
Q6. A 25-year-old man with borderline personality disorder has difficulty regulating his emotions and frequently
engages in self-harm. His therapist teaches him mindfulness skills, distress tolerance, emotion regulation, and
interpersonal effectiveness. This treatment model was developed by Marsha Linehan and is known as which
therapy?
A. Cognitive behavioral therapy for personality disorders using standard cognitive restructuring techniques
B. Dialectical behavior therapy which balances acceptance and change strategies for emotion
dysregulation
C. Schema therapy which identifies and modifies early maladaptive schemas through limited reparenting
D. Mentalization-based therapy which enhances the capacity to understand mental states in self and others
Correct Answer: B
Rationale:
DBT, developed by Marsha Linehan, teaches four skills modules (mindfulness, distress tolerance, emotion
regulation, interpersonal effectiveness) and balances acceptance and change strategies specifically for BPD.
Standard CBT (choice A) does not include these specific modules or the dialectical framework. Schema therapy
(choice C) targets early maladaptive schemas. Mentalization-based therapy (choice D) focuses on mentalizing
capacity.
NRNP 6645 Psychotherapy -- 2026/2027 | Passing Score: 80% | Page 3 of 0
NRNP 6645 Psychotherapy
Midterm Exam
Official Practice Exam . 2026/2027 Edition
100 Questions | 120 Minutes | 80% Passing Score | 6 Sections
TABLE OF CONTENTS
Section 1: Psychotherapy Theories and Models (17 Questions)
Section 2: Therapeutic Alliance and Relationship (12 Questions)
Section 3: Assessment and Treatment Planning in Psychotherapy (13 Questions)
Section 4: Evidence-Based Psychotherapy Interventions (14 Questions)
Section 5: Ethical, Legal, and Professional Issues (11 Questions)
Section 6: Special Populations, Outcomes, and Advanced Techniques (33 Questions)
EXAM INSTRUCTIONS
Read each question carefully. Select the single best answer from the four options provided. Each question includes a
rationale explaining the correct answer and why a key distractor is incorrect. A score of 80% or higher (80 of 100) is
required to pass. Manage your time to allow approximately 1.2 minutes per question. Review all answers before
submission.
NRNP 6645 Psychotherapy -- 2026/2027 | Passing Score: 80% | Page 0 of 0
NRNP 6645 Psychotherapy Midterm Exam | Walden University | 2026/2027 Edition
,Section 1: Psychotherapy Theories and Models
Q1. Question 1 of 100
Q1. A 35-year-old woman in psychotherapy describes a recurring dream about being trapped in a small room with
no doors. The therapist explores how this dream might represent unconscious conflicts from childhood. This
approach is most consistent with which theoretical model?
A. Psychodynamic psychotherapy which emphasizes unconscious processes, dream analysis, and
the influence of early childhood experiences on current functioning
B. Cognitive behavioral therapy which focuses on identifying and restructuring distorted thought patterns
that maintain psychological distress
C. Person-centered therapy which prioritizes the client's subjective experience and innate capacity for
self-actualization through unconditional positive regard
D. Existential therapy which addresses concerns about freedom, responsibility, and the search for meaning
in human existence
Correct Answer: A
Rationale:
The therapist's focus on unconscious processes, dream analysis, and childhood conflicts is the hallmark of
psychodynamic psychotherapy, rooted in Freudian and neo-Freudian theory. CBT (choice B) would focus on
conscious thoughts and behaviors, not dreams. Person-centered therapy (choice C) avoids interpretation and
follows the client's lead. Existential therapy (choice D) addresses meaning and freedom, not unconscious conflict.
Q2. Question 2 of 100
Q2. A 42-year-old man with depression tells his therapist that he must be perfect at work or he is a complete
failure. The therapist helps him examine the evidence for and against this belief and generates alternative
thoughts. This intervention is a core technique of which therapeutic approach?
A. Gestalt therapy using the empty chair technique to dialogue with critical internal voices
B. Cognitive behavioral therapy using cognitive restructuring to challenge all-or-nothing thinking
patterns
C. Psychodynamic therapy using free association to uncover the origin of perfectionistic defenses
D. Solution-focused brief therapy using the miracle question to envision life without perfectionism
Correct Answer: B
Rationale:
Examining evidence for and against beliefs and generating alternative thoughts is cognitive restructuring, a core
CBT technique targeting cognitive distortions like all-or-nothing thinking. The empty chair (choice A) is a Gestalt
experiential technique. Free association (choice C) is a psychodynamic method for accessing unconscious
material. The miracle question (choice D) is a solution-focused technique for building a vision of change.
NRNP 6645 Psychotherapy -- 2026/2027 | Passing Score: 80% | Page 1 of 0
,Q3. Question 3 of 100
Q3. A 28-year-old woman in therapy says she feels stuck and directionless in life. The therapist reflects her
feelings and says, 'It sounds like you are struggling to find what gives your life meaning and purpose.' The
therapist then explores the client's sense of freedom and responsibility in creating meaning. This approach is
most consistent with which theoretical orientation?
A. Behavioral therapy using contingency management to increase adaptive behaviors
B. Dialectical behavior therapy using distress tolerance skills to manage existential anxiety
C. Existential therapy addressing the client's struggle with meaning, freedom, and authentic
existence
D. Adlerian therapy exploring the client's inferiority complex and style of life
Correct Answer: C
Rationale:
The focus on meaning, purpose, freedom, and responsibility is characteristic of existential therapy, which helps
clients confront the givens of existence including meaninglessness and the freedom to create meaning.
Behavioral therapy (choice A) focuses on observable behavior change. DBT (choice B) targets emotion
dysregulation. Adlerian therapy (choice D) focuses on inferiority and social interest, not existential givens.
Q4. Question 4 of 100
Q4. A 50-year-old man in group therapy becomes tearful when discussing his divorce. The therapist invites him to
stay with his feelings and notice what he experiences in his body right now. The therapist asks him to speak
directly to the group about his experience. This intervention exemplifies which therapeutic approach?
A. Cognitive therapy identifying automatic thoughts associated with the emotional distress
B. Psychodynamic therapy interpreting transference patterns within the group setting
C. Rational emotive behavior therapy disputing irrational beliefs about divorce
D. Gestalt therapy emphasizing present-moment awareness, bodily experience, and here-and-now
contact with others
Correct Answer: D
Rationale:
The emphasis on present-moment awareness, bodily sensation, and direct contact with others in the
here-and-now is characteristic of Gestalt therapy, which prioritizes awareness and contact over interpretation or
cognitive analysis. Cognitive therapy (choice A) would focus on thoughts. Psychodynamic therapy (choice B)
would explore transference and unconscious material. REBT (choice C) would dispute irrational beliefs.
NRNP 6645 Psychotherapy -- 2026/2027 | Passing Score: 80% | Page 2 of 0
, Q5. Question 5 of 100
Q5. A therapist working with a 30-year-old woman with social anxiety uses exposure hierarchies, behavioral
experiments, and skills training while assigning between-session practice tasks. The therapist also collaboratively
develops a formulation linking thoughts, feelings, and behaviors. This integrated approach represents which
evidence-based model?
A. Cognitive behavioral therapy which integrates cognitive restructuring with behavioral activation
and exposure techniques
B. Psychodynamic psychotherapy which uses the therapeutic relationship to resolve intrapsychic conflicts
C. Acceptance and commitment therapy which uses mindfulness and values-based action to increase
psychological flexibility
D. Interpersonal psychotherapy which focuses on resolving interpersonal problems that maintain
depressive symptoms
Correct Answer: A
Rationale:
Exposure hierarchies, behavioral experiments, skills training, homework, and cognitive formulation are core
components of CBT. Psychodynamic therapy (choice B) does not use exposure hierarchies or homework. ACT
(choice C) uses mindfulness and values rather than exposure hierarchies and cognitive restructuring. IPT (choice
D) focuses on interpersonal problems, not cognitive-behavioral techniques.
Q6. Question 6 of 100
Q6. A 25-year-old man with borderline personality disorder has difficulty regulating his emotions and frequently
engages in self-harm. His therapist teaches him mindfulness skills, distress tolerance, emotion regulation, and
interpersonal effectiveness. This treatment model was developed by Marsha Linehan and is known as which
therapy?
A. Cognitive behavioral therapy for personality disorders using standard cognitive restructuring techniques
B. Dialectical behavior therapy which balances acceptance and change strategies for emotion
dysregulation
C. Schema therapy which identifies and modifies early maladaptive schemas through limited reparenting
D. Mentalization-based therapy which enhances the capacity to understand mental states in self and others
Correct Answer: B
Rationale:
DBT, developed by Marsha Linehan, teaches four skills modules (mindfulness, distress tolerance, emotion
regulation, interpersonal effectiveness) and balances acceptance and change strategies specifically for BPD.
Standard CBT (choice A) does not include these specific modules or the dialectical framework. Schema therapy
(choice C) targets early maladaptive schemas. Mentalization-based therapy (choice D) focuses on mentalizing
capacity.
NRNP 6645 Psychotherapy -- 2026/2027 | Passing Score: 80% | Page 3 of 0
