Psychotherapy: Modalities, Mechanisms, and Indications
Questions test whether you can match a therapy to a presentation and understand its active ingredients. Cognitive-behavioral therapy targets maladaptive cognitions and avoidance behaviors; it is first-line for panic disorder, OCD (with exposure and response prevention), and many anxiety disorders, and effective for depression. Psychodynamic therapy addresses unconscious conflict, transference, and defense mechanisms. Dialectical behavior therapy combines skills training with validation for borderline personality disorder and chronic suicidality. Interpersonal therapy focuses on role transitions and grief. Motivational interviewing uses reflective listening to resolve ambivalence. Family and couples therapy address systemic patterns.
Traps
- Assuming therapy is interchangeable across diagnoses; for example, insight-oriented therapy alone is not first-line for OCD.
- Confusing supportive therapy with exploratory therapy.
- Overlooking that combined medication and psychotherapy often outperforms either alone in moderate-to-severe depression.
- Boundary issues, informed consent, and competence when starting therapy.
Rule of thumb
Ask: what is the target-behavior, cognition, affect regulation, relationships, or insight? Then pick the modality matched to that target. Worked example: a patient with recurrent panic and avoidance of crowds benefits most from CBT with interoceptive and situational exposure; a purely supportive approach may reduce distress but not the avoidance maintaining the disorder.