Target
Define the symptoms, behaviors, relationships, functioning, or recovery goal the therapy is intended to change.
BH
Brooke Harbor Health System
PMHNP Clinical Learning Environment
Updated July 31, 2026
PMHNP Clinical Toolbox
Psychotherapy Modalities
Select psychotherapy by clinical target, evidence, patient fit, and delivery requirements, with diagnosis and modality name serving as only part of the selection process.
Selection framework
Six questions before choosing a modality
Evidence
Match the modality to the diagnosis, phase of illness, age, comorbidity, and current guideline recommendations.
Readiness
Consider motivation, cognitive capacity, emotional stability, substance use, safety, and ability to participate.
Fit
Discuss culture, language, identity, prior therapy, preferences, accessibility, cost, schedule, and treatment burden.
Delivery
Specify individual, family, group, couples, integrated, digital, or higher-intensity treatment—and who is qualified to provide it.
Measurement
Name the outcomes, review interval, and findings that would support continuing, adapting, or changing the plan.
Clinical orientation
Major modality families
Use this selection guide alongside a treatment manual, supervised training, and current condition-specific guidance.
Cognitive & behavioral
CBT · Behavioral Activation · CBT-I · CBTp · CBT-ETargets patterns among thoughts, emotions, behavior, avoidance, routines, and functioning through structured, collaborative work.
Clinical cautionUse a diagnosis- and population-specific protocol when one is indicated; generic supportive work is not equivalent to a manualized treatment.
Exposure & response-based
ERP · Prolonged Exposure · Exposure-based CBT · Habit Reversal · CBITUses planned practice with feared cues, avoided situations, intrusive experiences, compulsions, or habitual responses.
Clinical cautionRequires a clear formulation, informed consent, pacing, safety assessment, and modality-specific competence. Do not improvise exposure procedures.
Trauma-focused
CPT · PE · EMDR · Trauma-focused CBTDirectly addresses trauma memories, meanings, avoidance, and associated symptoms using an evidence-based trauma protocol.
Clinical cautionTrauma-informed care is essential across settings. Delivering trauma-focused psychotherapy requires an evidence-based protocol and modality-specific competence.
Interpersonal, relational & family
IPT · IPSRT · Family-Focused Therapy · Family-Based Treatment · Couples/Family TherapyAddresses interpersonal roles, grief, conflict, social rhythms, communication, attachment, and family patterns that affect illness or recovery.
Clinical cautionClarify who the patient is, confidentiality boundaries, consent, treatment goals, and how family or partners will participate.
Skills, acceptance & mindfulness
DBT · ACT · MBCT · MBSR · emotion-regulation skillsBuilds behavioral skills, distress tolerance, psychological flexibility, present-moment awareness, and values-guided action.
Clinical cautionDocument exactly which skills were provided and reserve the full treatment-model label for care that follows that model.
Motivation, recovery & behavior change
MI · Relapse Prevention · Contingency Management · CRA · harm-reduction approachesStrengthens motivation, supports recovery, changes reinforcement patterns, reduces harm, and builds practical relapse-prevention plans.
Clinical cautionMatch the intervention to the patient’s stage of change, treatment goals, substance-related risk, available supports, and program capacity.
Psychodynamic & insight-oriented
Brief psychodynamic therapy · supportive-expressive approachesExplores recurring patterns, defenses, relationships, affect, meaning, and the therapeutic relationship.
Clinical cautionSelect the intensity and frame based on goals, stability, reflective capacity, time, setting, and clinician training.
Supportive & integrated care
Supportive psychotherapy · psychoeducation · problem-solving · care-management interventionsStrengthens coping, alliance, functioning, treatment engagement, problem solving, and adaptation during illness or stress.
Clinical cautionSupportive care can be clinically valuable, but document its purpose and do not label it as a specialized evidence-based protocol.
Role clarity
The PMHNP may integrate, provide, refer, and coordinate
The appropriate role varies with education, supervised preparation, competence, licensure and organizational requirements, treatment complexity, and available services.
Integrate
Use therapeutic communication, psychoeducation, motivational strategies, brief behavioral techniques, and collaborative goal-setting within appropriate scope and competence.
Provide
Deliver psychotherapy only when education, supervised preparation, credentialing, setting expectations, and continuing competence support the specific modality.
Refer
Connect the patient with a qualified therapist or program when a structured protocol, family treatment, specialty population, or higher intensity is needed.
Coordinate
With consent, align diagnoses, goals, medication decisions, safety plans, outcome measures, and follow-up across clinicians.
Referral & coordination
Make the psychotherapy plan actionable
State the target problem, working diagnosis, clinical priority, desired modality or program, urgency, and relevant safety or access considerations.
Explain what the therapy involves, expected participation, alternatives, likely time course, cost or access barriers, and how progress will be reviewed.
Clarify consent, communication method, prescriber and therapist responsibilities, rating scales, safety planning, and who will respond to deterioration.
Confirm whether care was established, reassess fit and engagement, trend target outcomes, and revise the plan when access or response is inadequate.
Modality resources
Explore evidence-based approaches
Use these resources to understand a modality’s purpose, structure, evidence, and training expectations. A guide or treatment companion can orient learning; competence to deliver the full therapy requires the appropriate training and supervision.
CBT-I Therapist Manual
Provider manualA structured VA manual for cognitive behavioral therapy for insomnia, including assessment, treatment components, and session guidance.
Open resourceCBT-i Coach
Treatment companionA VA/DoD companion app intended for patients who are completing CBT-I with a trained health professional.
Open resourceExposure and Response Prevention
Clinical overviewThe International OCD Foundation explains ERP, its core components, and its role in evidence-based OCD treatment.
Open resourceIOCDF Training Institute
Training pathwayFoundational and advanced professional training opportunities in ERP and treatment of OCD-related disorders.
Open resourceCognitive Processing Therapy
Clinical overviewVA National Center for PTSD guidance on the rationale, structure, evidence, and delivery considerations for CPT.
Open resourceProlonged Exposure
Clinical overviewVA National Center for PTSD guidance on the components, evidence, and clinical delivery of PE.
Open resourceEMDR for PTSD
Clinical overviewVA National Center for PTSD review of EMDR, its treatment structure, evidence base, and practice considerations.
Open resourceACT Strategies Guide
Clinician guideA VA clinician resource organized around core ACT processes, with case examples, exercises, and handouts.
Open resourceACT Coach
Treatment companionA free VA app designed as a companion to clinician-delivered Acceptance and Commitment Therapy.
Open resourceUsing Motivational Interviewing
Practice advisoryA concise SAMHSA advisory introducing the spirit, processes, and clinical application of motivational interviewing.
Open resourceEnhancing Motivation for Change
Provider guideSAMHSA TIP 35 provides detailed guidance on motivation, stages of change, counseling strategies, and treatment engagement.
Open resourceTreatment of Stimulant Use Disorders
Evidence-based guideSAMHSA guidance covering contingency management, CBT, community reinforcement, motivational interviewing, and related approaches.
Open resourceAuthoritative starting points
Guidelines and implementation resources
Depression Treatment Guideline
Evidence-based treatment recommendations across children and adolescents, adults, and older adults.
Open resourcePTSD Treatment Guideline
Current recommendations and supporting materials for psychological and medication treatments for PTSD in adults.
Open resourceOverview of Psychotherapy for PTSD
Clinical overview of trauma-focused psychotherapies, shared decision-making, treatment selection, and fidelity.
Open resourceUsing Motivational Interviewing
Practical advisory on the spirit, processes, and clinical use of motivational interviewing.
Open resourceEvidence-Based Practices Resource Center
Practice resources for mental health, substance-use treatment, recovery, integrated care, and service delivery.
Open resourceMental Health Guidance
Condition-specific recommendations for psychological treatment, medication, service delivery, and follow-up.
Open resource