CASC: Supportive psychotherapy — demoralisation after job loss

Ten-minute station: engage a demoralised patient with depression after job loss, deliver supportive psychotherapy techniques (alliance, validation, praise, collaborative problem-solving), check risk, set a next-step plan, and safety-net while CBT is waitlisted.

Prompt

CASC: Supportive psychotherapy — demoralisation after job loss

Candidate instructions

You are the psychiatry registrar. Alex, 46, recurrent depression, lost a job three weeks ago. On sertraline 100 mg daily. PHQ-9 last week 16. No psychosis. Passive death wishes when most demoralised; no plan or intent today. CBT waitlist ~6 months. Feels "talking won't help" and that you will only "push antidepressants." Tasks in 10 minutes:^[5]^[7]

Engage and set a collaborative agenda (mood, job stress, meds, what would help today).
Explain supportive work in plain language (not jargon, not "just chat").
Use at least three techniques: validation, praise of adaptive effort, collaborative problem-solving for one next step.
Screen suicide risk and safety-net.
Agree follow-up and what success looks like this week.
Maintain a professional frame if Alex tests for special after-hours dual-role help.

^[5] ^[7] ^[14]

References7Show

[1]Winston A, Pinsker H, McCullough L A review of supportive psychotherapy Hosp Community Psychiatry, 1986.PMID 3781499
[5]Markowitz JC Supportive Evidence: Brief Supportive Psychotherapy as Active Control and Clinical Intervention Am J Psychother, 2022.PMID 35232221
[6]Dotson S, Markowitz JC Planting the Tree Right-Side Up: Supportive Psychotherapy as a Priority in Residency Training Acad Psychiatry, 2025.PMID 40921918
[7]Misch DA Basic strategies of dynamic supportive therapy J Psychother Pract Res, 2000.PMID 11069130
[11]Flückiger C, Del Re AC, Wampold BE, Horvath AO The alliance in adult psychotherapy: A meta-analytic synthesis Psychotherapy (Chic), 2018.PMID 29792475
[12]Safran JD, Muran JC, Eubanks-Carter C Repairing alliance ruptures Psychotherapy (Chic), 2011.PMID 21401278
[14]Gutheil TG, Gabbard GO The concept of boundaries in clinical practice: theoretical and risk-management dimensions Am J Psychiatry, 1993.PMID 8422069

CASC: Supportive psychotherapy — demoralisation after job loss

Candidate instructions

Engage and set a collaborative agenda (mood, job stress, meds, what would help today).

Explain supportive work in plain language (not jargon, not "just chat").

Use at least three techniques: validation, praise of adaptive effort, collaborative problem-solving for one next step.

Screen suicide risk and safety-net.

Agree follow-up and what success looks like this week.

Maintain a professional frame if Alex tests for special after-hours dual-role help.

References7Show

[1]Winston A, Pinsker H, McCullough L A review of supportive psychotherapy Hosp Community Psychiatry, 1986.PMID 3781499
[5]Markowitz JC Supportive Evidence: Brief Supportive Psychotherapy as Active Control and Clinical Intervention Am J Psychother, 2022.PMID 35232221
[6]Dotson S, Markowitz JC Planting the Tree Right-Side Up: Supportive Psychotherapy as a Priority in Residency Training Acad Psychiatry, 2025.PMID 40921918
[7]Misch DA Basic strategies of dynamic supportive therapy J Psychother Pract Res, 2000.PMID 11069130
[11]Flückiger C, Del Re AC, Wampold BE, Horvath AO The alliance in adult psychotherapy: A meta-analytic synthesis Psychotherapy (Chic), 2018.PMID 29792475
[12]Safran JD, Muran JC, Eubanks-Carter C Repairing alliance ruptures Psychotherapy (Chic), 2011.PMID 21401278
[14]Gutheil TG, Gabbard GO The concept of boundaries in clinical practice: theoretical and risk-management dimensions Am J Psychiatry, 1993.PMID 8422069