Question time again!

A social worker employed at an agency that offers short-term mental health services is treating a client with major depressive disorder who she will be working with for the next six months. Which is the MOST appropriate treatment approach?*

A. Insight-oriented therapy.
B. Person-centered therapy.
C. Cognitive-behavioral therapy.
D. Solution-focused brief therapy.

The answer is…C. Meanwhile, my psychodynamic friends have heart attacks and defriend me on Facebook…but wait!

One of the important things about the social work exam section that assesses our intervention planning skills is not only knowing general research about evidence-based practices for different presenting issues client may present with, but also knowing how to work within the resources of our practice setting.

In this question, short-term services is a key phrase because the question is asking us, using available research, and the time-limited practice-setting, which is the most appropriate treatment for presenting diagnosis, not which is the “best treatment” period.  For example, dialectical-behavioral therapy (DBT), pioneered by Dr. Marsha Linehan, is generally considered an accepted treatment modality for borderline personality disorder.

Insight-oriented therapy (derived from psychodynamic therapy and/or referring to psychodynamic therapy in general) and person-centered therapy (think Carl Rogers, humanistic therapy, and the self-actualizing theory) could be appropriate (which is great, as I myself am strongly influenced by both), but they are generally long-term modalities.

Solution-focused brief therapy is generally time-limited, sometimes as short as a 5 or less sessions (!), but would not be immediately appropriate for this client.

If you decide to pursue clinical social work, you will inevitably have to negotiate your internal theoretical leanings, which themselves take a long time to fully develop, with your practice setting’s limitations.  This in turn may lead to further growth if you decide to do institute work, such as psychoanalytic training; want to specialize in treating clients with certain vulnerabilities, or want to increase advocacy for implementing more of a certain type of treatment. Your beginning years as a social worker will plant those seeds that will balance, as a coworker of mine once said, the sciene (evidence) and art (use of self) of doing good therapy.

*Credit: Question written by writer of blog but adapted from a similar ASWB practice exam question re: treatment modalities.