Psychotherapy and Clinical Intervention
What this domain tests
This domain tests whether you can plan, deliver, and monitor a psychological intervention grounded in formulation and evidence, rather than in eclectic improvisation.
Core rules
- Begin with a formulation and a shared, measurable target. Measure at baseline and at intervals; adjust if there is no response.
- Match technique to problem: exposure-based CBT for panic, OCD, and PTSD; behavioural activation and CBT for depression; DBT skills for emotion dysregulation and self-harm; motivational interviewing for ambivalence; family interventions where expressed emotion is high.
- Keep session structure: agenda, bridge from last session, homework review, active work, summary, and a new agreed task.
- Exposure works chiefly through expectancy violation, so safety behaviours and subtle avoidance must be dropped and the rationale explained.
- The alliance is necessary but not sufficient. Monitor ruptures and deterioration rather than assuming good intentions are enough.
Worked example
A patient with panic disorder and agoraphobia fears that a racing heart means a heart attack. Sequence: psychoeducation and a breathing-retraining caveat; interoceptive exposure (straw breathing, stair climbing, spinning) to violate the catastrophe prediction; then a graded in-vivo hierarchy with the therapist reducing reassurance. Rationale: targeting the misinterpretation first prevents the in-vivo work from becoming another safety behaviour. Progress is tracked on a panic severity measure, not on the patient's reassurance seeking.
Traps that cost marks
Reassurance offered as treatment; starting trauma narration before any stabilisation or skills; stacking many techniques without a formulation; blaming dropout on the patient's personality; and ignoring the cultural meaning a patient attaches to somatic symptoms.