Treatment, Intervention, Prevention, and Supervision
These stems present a treatment decision, a stalled intervention, a prevention program, or a supervisory dilemma. You are expected to match the intervention to the mechanism, respect the client's stage of change, and know where the supervisor's responsibility lies.
Selecting and delivering interventions
- CBT is indicated for panic, social anxiety, OCD, and depression; exposure must be prolonged enough for habituation and conducted without safety behaviors or subtle avoidance.
- Systematic desensitization pairs a hierarchy with relaxation; flooding begins at the top of the hierarchy and should be reserved for robust, motivated clients.
- DBT modules are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness; it is first-line psychosocial treatment for borderline personality disorder and repeated self-harm.
- Motivational interviewing uses OARS (open questions, affirmations, reflections, summaries) and matches Prochaska's stages: precontemplation calls for raising doubt, not action planning.
Prevention levels
- Caplan: primary reduces incidence before onset, secondary provides early detection and short-course treatment, tertiary reduces disability and recurrence.
- The IOM/NAM framework classifies prevention as universal, selective, or indicated by risk level, not by timing alone.
Group and systems work
- Yalom's therapeutic factors include universality, instillation of hope, interpersonal learning, group cohesiveness, and catharsis.
- Structural family therapy targets boundaries and hierarchies; enmeshment and disengagement are its central vocabulary.
Supervision
- Supervisors carry responsibility for client welfare; disclose the supervisor's name and the supervisee's trainee status at intake and obtain consent to supervision.
- Bernard's discrimination model: teacher, counselor, and consultant roles across process, conceptualization, and personalization foci.
- Evaluate, document, and address supervisee impairment or incompetence directly rather than avoiding it.
Worked example
A client with contamination OCD washes for two hours daily. The therapist teaches relaxation and asks him to wash less when he feels ready. This fails on mechanism: washing reduces anxiety, negatively reinforcing the compulsion, so relaxation plus a vague request leaves the contingency intact. The correct plan is hierarchical exposure to contaminants with strict response prevention, negotiated in advance, with no reassurance provision.
Traps
- Using flooding with a client who cannot tolerate intense arousal.
- Equating 12-step attendance with evidence-based psychotherapy.
- Practicing therapy on a supervisee; supervision concerns the supervisee's clinical work.
- Mislabeling secondary prevention as tertiary, or tertiary as treatment as usual.