,NRNP 6645 Psychotherapy With Multiple
Modalities Exam Prep — Comprehensive Review +
Practice MCQs — Walden University 2025/2026
Question 1
A PMHNP student is beginning their first psychotherapy session with a 34-year-old client diagnosed with
generalized anxiety disorder. The client asks, “So how does this therapy thing actually work?” Which response
best establishes the therapeutic frame?
A. “I’ll explain all the techniques we’ll use over the next 12 weeks so you know exactly what to expect.”
B. “Therapy works by helping you understand your unconscious conflicts from childhood.”
C. “Let me first learn more about what brings you here, and then we can discuss how we’ll work together.”
D. “I’ll give you a workbook to complete between sessions; that’s the core of the treatment.”
Correct Answer: C
Rationale: Establishing the therapeutic frame begins with understanding the client’s concerns and
collaboratively defining the work. Providing a full technique roadmap before assessment is premature. Option
B imposes a single theoretical orientation before understanding the client’s needs. Option D reduces
psychotherapy to workbook completion, which misrepresents the modality.
Question 2
A client states, “I feel like you’re the only person who truly gets me. I wish we could be friends outside of
here.” Which interpretation is most accurate?
,A. A genuine compliment that should be accepted to strengthen rapport
B. Erotic transference requiring immediate boundary-setting confrontation
C. A manifestation of loneliness and idealization that should be explored therapeutically
D. Resistance against discussing painful material
Correct Answer: C
Rationale: This statement reflects unmet emotional needs and idealization of the therapist. While positive
transference is present, the therapeutic task is to explore the underlying loneliness and the meaning of the
wish for a friendship. Confrontation may shame the client; acceptance would violate boundaries.
Question 3
In the initial phase of psychotherapy, the most critical task for the PMHNP is to:
A. Formulate a complete psychodynamic diagnosis
B. Establish a strong therapeutic alliance
C. Assign homework to the client
D. Identify all of the client’s cognitive distortions
Correct Answer: B
Rationale: Research consistently demonstrates that the therapeutic alliance is one of the strongest predictors
of positive outcomes across all therapeutic modalities. Diagnosis, homework, and cognitive assessment are
important but secondary to building trust and a collaborative working relationship.
, Question 4
A therapist notices feeling unusually angry and impatient with a client who consistently arrives 10 minutes
late. The therapist’s best course of action is to:
A. Confront the client about their disrespectful behavior
B. Explore the countertransference feelings with a supervisor or in personal therapy
C. Terminate the client for non-compliance
D. Ignore the feelings and continue as usual
Correct Answer: B
Rationale: Countertransference refers to the therapist’s emotional reactions to the patient, which can provide
valuable information about the therapeutic relationship. The therapist should explore these feelings with a
supervisor to understand their origin and use them therapeutically.
Question 5
A 28-year-old female client with borderline personality disorder becomes intensely angry when the therapist
maintains the session time boundary. The therapist notices feeling defensive and wishing to prove she cares.
Which concept is most relevant?
A. Therapeutic rupture requiring immediate termination
B. Transference and countertransference dynamics requiring exploration and containment
C. Client resistance indicating poor treatment fit
D. Therapist failure to establish adequate rapport
Correct Answer: B
Modalities Exam Prep — Comprehensive Review +
Practice MCQs — Walden University 2025/2026
Question 1
A PMHNP student is beginning their first psychotherapy session with a 34-year-old client diagnosed with
generalized anxiety disorder. The client asks, “So how does this therapy thing actually work?” Which response
best establishes the therapeutic frame?
A. “I’ll explain all the techniques we’ll use over the next 12 weeks so you know exactly what to expect.”
B. “Therapy works by helping you understand your unconscious conflicts from childhood.”
C. “Let me first learn more about what brings you here, and then we can discuss how we’ll work together.”
D. “I’ll give you a workbook to complete between sessions; that’s the core of the treatment.”
Correct Answer: C
Rationale: Establishing the therapeutic frame begins with understanding the client’s concerns and
collaboratively defining the work. Providing a full technique roadmap before assessment is premature. Option
B imposes a single theoretical orientation before understanding the client’s needs. Option D reduces
psychotherapy to workbook completion, which misrepresents the modality.
Question 2
A client states, “I feel like you’re the only person who truly gets me. I wish we could be friends outside of
here.” Which interpretation is most accurate?
,A. A genuine compliment that should be accepted to strengthen rapport
B. Erotic transference requiring immediate boundary-setting confrontation
C. A manifestation of loneliness and idealization that should be explored therapeutically
D. Resistance against discussing painful material
Correct Answer: C
Rationale: This statement reflects unmet emotional needs and idealization of the therapist. While positive
transference is present, the therapeutic task is to explore the underlying loneliness and the meaning of the
wish for a friendship. Confrontation may shame the client; acceptance would violate boundaries.
Question 3
In the initial phase of psychotherapy, the most critical task for the PMHNP is to:
A. Formulate a complete psychodynamic diagnosis
B. Establish a strong therapeutic alliance
C. Assign homework to the client
D. Identify all of the client’s cognitive distortions
Correct Answer: B
Rationale: Research consistently demonstrates that the therapeutic alliance is one of the strongest predictors
of positive outcomes across all therapeutic modalities. Diagnosis, homework, and cognitive assessment are
important but secondary to building trust and a collaborative working relationship.
, Question 4
A therapist notices feeling unusually angry and impatient with a client who consistently arrives 10 minutes
late. The therapist’s best course of action is to:
A. Confront the client about their disrespectful behavior
B. Explore the countertransference feelings with a supervisor or in personal therapy
C. Terminate the client for non-compliance
D. Ignore the feelings and continue as usual
Correct Answer: B
Rationale: Countertransference refers to the therapist’s emotional reactions to the patient, which can provide
valuable information about the therapeutic relationship. The therapist should explore these feelings with a
supervisor to understand their origin and use them therapeutically.
Question 5
A 28-year-old female client with borderline personality disorder becomes intensely angry when the therapist
maintains the session time boundary. The therapist notices feeling defensive and wishing to prove she cares.
Which concept is most relevant?
A. Therapeutic rupture requiring immediate termination
B. Transference and countertransference dynamics requiring exploration and containment
C. Client resistance indicating poor treatment fit
D. Therapist failure to establish adequate rapport
Correct Answer: B
