NRNP 6645 FiNal ExamiNatioN, 2026/2027 PsychothERaPy
with iNdividuals – PmhNP comPEtENcy assEssmENt
waldEN uNivERsity
SECTION 1: PSYCHODYNAMIC AND PSYCHOANALYTIC THERAPIES (Questions 1-10)
**Question 1**
A patient in psychodynamic psychotherapy repeatedly arrives late to sessions and has missed
two appointments without calling. The therapist notes that this behavior pattern reminds her of
how the patient's mother described his adolescent behavior. The therapist is experiencing:
A) Countertransference
B) Transference
C) Projective identification
D) Free association
**Answer:** A) Countertransference
**Rationale:** Countertransference refers to the therapist's emotional reactions, thoughts, and
fantasies toward the patient that are based on the therapist's own unconscious conflicts or past
relationships. Here, the therapist's recognition that the patient's lateness reminds her of the
mother's description is an example of countertransference awareness. Transference (B) is the
patient's projection onto the therapist. Projective identification (C) involves the patient
projecting a feeling into the therapist, who then feels it. Free association (D) is a technique
where patients say whatever comes to mind.
---
**Question 2**
A patient undergoing psychoanalysis begins to view the analyst as a nurturing parent figure,
seeking approval and expressing gratitude for perceived care. This phenomenon is known as:
,A) Countertransference
B) Positive transference
C) Negative transference
D) Therapeutic alliance
**Answer:** B) Positive transference
**Rationale:** Positive transference occurs when the patient projects positive feelings,
attitudes, and fantasies onto the analyst, often based on early relationships with loving or
nurturing figures. This can be therapeutic when it allows the patient to re-experience and work
through relationship patterns. Negative transference involves hostile or angry feelings.
Countertransference involves the analyst's reactions. The therapeutic alliance is the conscious,
collaborative working relationship.
---
**Question 3**
During a psychodynamic therapy session, the patient expresses anger toward the therapist,
stating, "You are just like my father—you never listen to me and you think you know what's best."
The therapist responds by helping the patient explore the connection between these feelings
and past relationships. This intervention is called:
A) Interpretation
B) Confrontation
C) Clarification
D) Transference interpretation
**Answer:** D) Transference interpretation
**Rationale:** Transference interpretation is a core psychodynamic technique where the
therapist helps the patient recognize and understand how feelings and attitudes from past
relationships are being displaced onto the therapist. This allows the patient to gain insight into
unconscious patterns. Interpretation (A) is a broader term. Confrontation (B) points out
discrepancies. Clarification (C) helps the patient elaborate on vague statements.
,---
**Question 4**
In psychoanalysis, the term "resistance" refers to:
A) The patient's aggressive behavior toward the therapist
B) The patient's unconscious defense mechanisms that impede the progress of therapy
C) The therapist's reluctance to explore painful topics
D) The patient's refusal to attend sessions
**Answer:** B) The patient's unconscious defense mechanisms that impede the progress of
therapy
**Rationale:** Resistance in psychoanalysis refers to the patient's unconscious efforts to avoid
the awareness of painful or threatening thoughts, feelings, and memories. Resistance can
manifest as missed appointments, silence, intellectualization, changing the subject, or forgetting
key information. Recognizing and interpreting resistance is a key aspect of psychoanalytic
technique.
---
**Question 5**
A patient reports a dream in which she is being chased by a large animal. The psychoanalyst
explores the latent content of the dream, which refers to:
A) The actual events as the patient remembers them
B) The hidden, symbolic meaning of the dream
C) The physical sensations experienced during the dream
D) The patient's waking thoughts about the dream
**Answer:** B) The hidden, symbolic meaning of the dream
, **Rationale:** In psychoanalytic theory, dreams have two levels: manifest content (the actual
dream as remembered) and latent content (the hidden, unconscious wishes, conflicts, and
symbolic meanings). The analyst works to interpret latent content to uncover unconscious
material. Freud described dreams as "the royal road to the unconscious."
---
**Question 6**
Psychodynamic psychotherapy differs from classical psychoanalysis primarily in that
psychodynamic psychotherapy:
A) Focuses exclusively on childhood experiences
B) Is typically less intensive (once weekly, face-to-face) and focuses more on current
relationships
C) Does not address unconscious processes
D) Requires the patient to lie on a couch
**Answer:** B) Is typically less intensive (once weekly, face-to-face) and focuses more on
current relationships
**Rationale:** While both approaches address unconscious processes, psychodynamic
psychotherapy is typically less intensive (usually once weekly versus 3-5 times weekly), often
uses a face-to-face seating arrangement (versus the couch), and places greater emphasis on
current relationships and life situations while still exploring how past patterns influence present
functioning.
---
**Question 7**
A patient in psychodynamic therapy states, "I don't know why I keep sabotaging my
relationships. I find someone good, and then I push them away." The therapist says, "You
mentioned earlier that your mother left when you were young. Can you tell me more about how
that experience might be influencing your current relationships?" This intervention is an
example of:
with iNdividuals – PmhNP comPEtENcy assEssmENt
waldEN uNivERsity
SECTION 1: PSYCHODYNAMIC AND PSYCHOANALYTIC THERAPIES (Questions 1-10)
**Question 1**
A patient in psychodynamic psychotherapy repeatedly arrives late to sessions and has missed
two appointments without calling. The therapist notes that this behavior pattern reminds her of
how the patient's mother described his adolescent behavior. The therapist is experiencing:
A) Countertransference
B) Transference
C) Projective identification
D) Free association
**Answer:** A) Countertransference
**Rationale:** Countertransference refers to the therapist's emotional reactions, thoughts, and
fantasies toward the patient that are based on the therapist's own unconscious conflicts or past
relationships. Here, the therapist's recognition that the patient's lateness reminds her of the
mother's description is an example of countertransference awareness. Transference (B) is the
patient's projection onto the therapist. Projective identification (C) involves the patient
projecting a feeling into the therapist, who then feels it. Free association (D) is a technique
where patients say whatever comes to mind.
---
**Question 2**
A patient undergoing psychoanalysis begins to view the analyst as a nurturing parent figure,
seeking approval and expressing gratitude for perceived care. This phenomenon is known as:
,A) Countertransference
B) Positive transference
C) Negative transference
D) Therapeutic alliance
**Answer:** B) Positive transference
**Rationale:** Positive transference occurs when the patient projects positive feelings,
attitudes, and fantasies onto the analyst, often based on early relationships with loving or
nurturing figures. This can be therapeutic when it allows the patient to re-experience and work
through relationship patterns. Negative transference involves hostile or angry feelings.
Countertransference involves the analyst's reactions. The therapeutic alliance is the conscious,
collaborative working relationship.
---
**Question 3**
During a psychodynamic therapy session, the patient expresses anger toward the therapist,
stating, "You are just like my father—you never listen to me and you think you know what's best."
The therapist responds by helping the patient explore the connection between these feelings
and past relationships. This intervention is called:
A) Interpretation
B) Confrontation
C) Clarification
D) Transference interpretation
**Answer:** D) Transference interpretation
**Rationale:** Transference interpretation is a core psychodynamic technique where the
therapist helps the patient recognize and understand how feelings and attitudes from past
relationships are being displaced onto the therapist. This allows the patient to gain insight into
unconscious patterns. Interpretation (A) is a broader term. Confrontation (B) points out
discrepancies. Clarification (C) helps the patient elaborate on vague statements.
,---
**Question 4**
In psychoanalysis, the term "resistance" refers to:
A) The patient's aggressive behavior toward the therapist
B) The patient's unconscious defense mechanisms that impede the progress of therapy
C) The therapist's reluctance to explore painful topics
D) The patient's refusal to attend sessions
**Answer:** B) The patient's unconscious defense mechanisms that impede the progress of
therapy
**Rationale:** Resistance in psychoanalysis refers to the patient's unconscious efforts to avoid
the awareness of painful or threatening thoughts, feelings, and memories. Resistance can
manifest as missed appointments, silence, intellectualization, changing the subject, or forgetting
key information. Recognizing and interpreting resistance is a key aspect of psychoanalytic
technique.
---
**Question 5**
A patient reports a dream in which she is being chased by a large animal. The psychoanalyst
explores the latent content of the dream, which refers to:
A) The actual events as the patient remembers them
B) The hidden, symbolic meaning of the dream
C) The physical sensations experienced during the dream
D) The patient's waking thoughts about the dream
**Answer:** B) The hidden, symbolic meaning of the dream
, **Rationale:** In psychoanalytic theory, dreams have two levels: manifest content (the actual
dream as remembered) and latent content (the hidden, unconscious wishes, conflicts, and
symbolic meanings). The analyst works to interpret latent content to uncover unconscious
material. Freud described dreams as "the royal road to the unconscious."
---
**Question 6**
Psychodynamic psychotherapy differs from classical psychoanalysis primarily in that
psychodynamic psychotherapy:
A) Focuses exclusively on childhood experiences
B) Is typically less intensive (once weekly, face-to-face) and focuses more on current
relationships
C) Does not address unconscious processes
D) Requires the patient to lie on a couch
**Answer:** B) Is typically less intensive (once weekly, face-to-face) and focuses more on
current relationships
**Rationale:** While both approaches address unconscious processes, psychodynamic
psychotherapy is typically less intensive (usually once weekly versus 3-5 times weekly), often
uses a face-to-face seating arrangement (versus the couch), and places greater emphasis on
current relationships and life situations while still exploring how past patterns influence present
functioning.
---
**Question 7**
A patient in psychodynamic therapy states, "I don't know why I keep sabotaging my
relationships. I find someone good, and then I push them away." The therapist says, "You
mentioned earlier that your mother left when you were young. Can you tell me more about how
that experience might be influencing your current relationships?" This intervention is an
example of:
