PMH-C Therapeutic Approaches 5 — Questions and Answers
Question 1: Which therapeutic approach is most appropriate for a perinatal client with a primary diagnosis of Borderline Personality Disorder experiencing postpartum mood instability?
- Standard supportive therapy without structured skills training
- Dialectical Behavior Therapy (DBT) with skills training in emotion regulation (Correct answer)
- Pure cognitive restructuring focusing only on depressive thoughts
- Strict behavioral contracts without emotional validation
Correct answer: Dialectical Behavior Therapy (DBT) with skills training in emotion regulation
DBT is the gold-standard treatment for BPD and provides essential emotion regulation and distress tolerance skills needed for postpartum stability.
Question 2: A therapist uses 'empty chair' technique during therapy with a postpartum client grieving a pregnancy loss. This technique is associated with which modality?
- Cognitive Processing Therapy
- Gestalt Therapy or Emotion-Focused Therapy (Correct answer)
- Prolonged Exposure Therapy
- Interpersonal Psychotherapy
Correct answer: Gestalt Therapy or Emotion-Focused Therapy
The empty chair technique is a hallmark of Gestalt therapy and Emotion-Focused Therapy, used to process unfinished business and complicated grief.
Question 3: What is the therapeutic rationale for including partners in perinatal mental health treatment sessions?
- Partners are legally required to attend all perinatal therapy sessions
- Partner inclusion improves social support, enhances communication, and promotes shared parenting responsibility (Correct answer)
- Partners must attend to give consent for the client's treatment
- Partner sessions replace individual therapy to reduce cost
Correct answer: Partner inclusion improves social support, enhances communication, and promotes shared parenting responsibility
Including partners builds social support, improves relationship communication, and helps partners understand and respond to perinatal mental health challenges.
Question 4: A perinatal therapist is working with a client using Acceptance and Commitment Therapy (ACT). Which metaphor best illustrates the ACT concept of psychological flexibility?
- The thought record chart showing evidence for and against beliefs
- Leaves floating on a stream, representing thoughts passing through awareness without attachment (Correct answer)
- A ladder of fear hierarchy for exposure work
- The cognitive triangle linking thoughts, feelings, and behaviors
Correct answer: Leaves floating on a stream, representing thoughts passing through awareness without attachment
The leaves on a stream metaphor in ACT helps clients practice defusion—observing thoughts as passing mental events rather than fixed truths requiring action.
Question 5: When a perinatal therapist notices countertransference feelings of over-protectiveness toward a client with severe postpartum depression, what is the most appropriate response?
- Ignore the feelings and maintain focus on the client's treatment goals
- Reflect on the countertransference in supervision to prevent it from interfering with treatment (Correct answer)
- Disclose the protective feelings openly to the client to build rapport
- Transfer the client to another therapist immediately
Correct answer: Reflect on the countertransference in supervision to prevent it from interfering with treatment
Countertransference should be explored in clinical supervision to understand its origins and prevent it from negatively impacting the therapeutic relationship or clinical decisions.
Question 6: Which phase of trauma-focused CBT is considered foundational before beginning trauma processing with a perinatal client?
- Trauma narrative development and cognitive processing
- Stabilization, safety, and skills-building phase (Correct answer)
- In vivo exposure to trauma reminders
- Grief work and loss processing
Correct answer: Stabilization, safety, and skills-building phase
Stabilization and skills-building must precede trauma processing to ensure the client has adequate coping resources to tolerate trauma work safely.
Question 7: A prenatal client with health anxiety frequently seeks reassurance about fetal wellbeing after normal OB appointments. What is the recommended therapeutic response?
- Provide reassurance each session to reduce distress and build trust
- Gently decline repeated reassurance and instead explore the function of reassurance-seeking behavior (Correct answer)
- Contact the OB to provide additional testing to eliminate client anxiety
- Refer immediately to psychiatry without addressing the behavior in therapy
Correct answer: Gently decline repeated reassurance and instead explore the function of reassurance-seeking behavior
In health anxiety and OCD, reassurance-seeking is a compulsion that temporarily reduces anxiety but reinforces the cycle; therapeutic work involves reducing reassurance rather than providing it.
PMH-C Therapeutic Approaches 5
Which therapeutic approach is most appropriate for a perinatal client with a primary diagnosis of Borderline Personality Disorder experiencing postpartum mood instability?