Top 5 MFT Case Scenarios to Study
Preparing for the Marriage and Family Therapy (MFT) exam means more than memorizing theories—it’s about applying systemic thinking to real-world situations. To help you bridge the gap between textbook knowledge and practical application, we’ve compiled five essential MFT case examples. Each one mirrors challenges you’re likely to see in practice—and on the exam.
MFT Case Scenario 1
You are working with Krista (44) and her husband, Allen (44) for issues related to Allen’s recent affair. Whenever any of you start talking about the affair, Krista becomes visibly distressed, as evidenced by intense crying and comments along the lines of, “I just can’t do this…I can’t talk about this.”
Her reaction BEST highlights:
A. Her becoming flooded
B. Her becoming defensive
C. Her becoming avoidant
D. Her becoming stonewalled
Correct answer: A. Her becoming flooded
Such hyperarousal likely indicates Krista becoming flooded during the session. If she kept rationalizing her behavior, that might be a form of defensiveness. Although she may want to avoid talking about the topic, her intense physiological symptoms show that flooding is more likely the case than becoming avoidant. Becoming avoidant might look like intellectualizing or minimizing the impact. Stonewalling would typically include having a stoic, detached, withdrawn stance.
Reference: An Introduction to Marriage and Family Therapy, 2nd Edition. Pg 405.
MFT Case Scenario 2
Leslie is a therapist who receives an email from a mother, Patricia (38), looking for support for her teenage daughter, Rochelle (15). She states that Rochelle is feeling ostracized by her peer group and is being harassed online by some classmates. However, when it’s time for your session, only Patricia shows up. She tells you, “Rochelle didn’t want to come. She wants to work with the therapist at her school instead. But can I still talk to you?”
As a narrative therapist, Leslie would most likely do what NEXT?
A. Discuss that it’s unethical for a client to work with two therapists at the same time
B. Refuse to see Patricia until Rochelle accompanies her
C. Agree to meet with Patricia to help resolve her problems
D. Refer Patricia and Rochelle to another family therapist (that Rochelle is willing to work with)
Correct answer: C. Agree to meet with Patricia to help resolve her problems
A narrative therapist often works with whoever is willing to attend therapy, focusing on empowering their story. Leslie would not automatically refuse to work with Patricia. It is not inherently unethical to work with two therapists, especially if roles and treatment goals differ. Clients often have separate school and private therapists when needs vary.
Reference: The National Licensing Exam for Marriage and Family Therapy, 2nd Edition. Pg 193.
MFT Case Scenario 3
Shanna (8) is a good student in school and generally well-behaved. However, her teacher has expressed concerns about how withdrawn Shanna can be at recess. She is extremely quiet and subdued. She seems to show no emotion when her parents drop her off or pick her up. When you set up a meeting with Shanna’s mother, Ellen, she states Shanna has always enjoyed playing quietly and that she has “never” cuddled, wanted to be held, or comforted by an adult caregiver. Ellen also indicates that she “dated around a lot” when Shanna was between ages 1–4, until she met Shanna’s stepfather.
Based on this information, you would MOST LIKELY diagnose Shanna with:
A. Generalized anxiety disorder
B. Selective mutism
C. Disinhibited social engagement disorder
D. Reactive attachment disorder
Correct answer: D. Reactive attachment disorder
Shanna presents with hallmark symptoms of reactive attachment disorder, including emotional withdrawal and minimal seeking of comfort. Selective mutism and generalized anxiety disorder are ruled out because Shanna’s issues appear more relational and emotional than verbal. Disinhibited social engagement would present with overly familiar behaviors with strangers, which is not the case here.
Reference: The National Licensing Exam for Marriage and Family Therapy, 2nd Edition. Pg 274.
MFT Case Scenario 4
Your client, Caleb, shares that he feels enormous pressure to marry someone who shares the same cultural background. He insists his parents have never pressured him directly, but he feels an intense expectation given longstanding family traditions.
From a transgenerational family therapy approach, Caleb’s struggle BEST represents an example of:
A. Invisible loyalty
B. Legacy
C. Indebtedness
D. Enmeshment
Correct answer: B. Legacy
Caleb is experiencing a sense of legacy—spoken or unspoken expectations passed down through generations. Invisible loyalty would involve unconscious commitments, but Caleb is fully aware of this pressure. Indebtedness would involve more tangible obligations, and enmeshment refers to blurred individual boundaries, which isn’t quite the case here.
Reference: An Introduction to Marriage and Family Therapy, 2nd Edition. Pg 333.
MFT Case Scenario 5
You are working with Tina, a working mother of three children who is coming into therapy with symptoms of chronic pain and anxiety. During the intake, she reports that she often finds herself saying “yes” to people and disregards her own needs to care for her children. She feels overwhelmed and sometimes doesn’t know where her children’s identities end and hers begins.
What type of boundaries does Tina MOST LIKELY have with others?
A. Diffuse
B. Covert
C. Rigid
D. Autonomous
Correct answer: A. Diffuse
Tina’s blurred sense of self and others points to diffuse boundaries. Covert boundaries refer to unspoken family rules; rigid boundaries would look like cold detachment, and autonomous boundaries reflect healthy individuality, none of which describe Tina’s situation.
Reference: An Introduction to Marriage and Family Therapy, 2nd Edition. Pg 61.
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Mastering MFT 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!
