Psychotherapy and Psychological Treatments
Modalities and indications
Know the theoretical basis and target of each modality. CBT targets maladaptive cognitions and behaviours; behavioural therapy/ERP for OCD and phobias; psychodynamic therapy explores unconscious conflict and transference; interpersonal therapy (IPT) targets role transitions, grief, disputes and deficits; DBT (Linehan) targets emotion dysregulation and self-harm, combining individual and group skills; MBCT prevents depressive relapse; family therapy and systemic therapy address relational patterns; motivational interviewing builds change talk in substance use.
Mechanisms and evidence
Understand exposure (habituation/extinction), cognitive restructuring, behavioural activation, and therapeutic alliance as a common factor. Know that CBT is first-line for many anxiety and depressive disorders, and that combined medication plus therapy is superior in moderate-severe depression.
Traps
- Assuming psychotherapy is contraindicated in psychosis - CBTp and family interventions are evidence-based adjuncts.
- Confusing transference (patient's feelings toward therapist) with countertransference (therapist's feelings toward patient).
- Forgetting confidentiality limits and boundary/ethical issues in therapy questions.
Worked example
A patient with recurrent depression who has had three episodes asks how to prevent relapse. The evidence-based answer is maintenance antidepressant and/or MBCT, not acute CBT alone - the question is about relapse prevention, so match the modality to the phase of illness.